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32919 N Center St Ste B Wittmann AZ 85361-9433 | |
(928) 668-1833 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 32919 N Center St Ste B, Wittmann, Arizona |
Authorized Official Name and Position | James Tavary (CEO) |
Authorized Official Contact | 9286845421 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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523 Rose Ln Wickenburg AZ 85390-1448 Ph: (928) 668-1845 | 32919 N Center St Ste B Wittmann AZ 85361-9433 Ph: (928) 668-1833 |
NPI Number | 1770097123 |
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Provider Enumeration Date | 11/21/2017 |
Last Update Date | 11/21/2017 |
Medicare PECOS PAC ID | 4981688900 |
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Medicare Enrollment ID | O20190508001059 |
Identifier | Type | State | Issuer |
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1770097123 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |