| Creosote Total Health | |
|
8380 S Kyrene Rd # D-103 Tempe AZ 85284-2120 | |
| (480) 269-3208 | |
| (480) 674-1295 |
| Full Name | Creosote Total Health |
|---|---|
| Speciality | Family Medicine |
| Location | 8380 S Kyrene Rd # D-103, Tempe, Arizona |
| Authorized Official Name and Position | Simon Sheard (PHYSICIAN/OWNER) |
| Authorized Official Contact | 4802693208 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creosote Total Health 8380 S Kyrene Rd # D-103 Tempe AZ 85284-2120 Ph: (480) 269-3208 | Creosote Total Health 8380 S Kyrene Rd # D-103 Tempe AZ 85284-2120 Ph: (480) 269-3208 |
| NPI Number | 1043928476 |
|---|---|
| Provider Enumeration Date | 11/15/2022 |
| Last Update Date | 04/17/2024 |
| Medicare PECOS PAC ID | 9335518323 |
|---|---|
| Medicare Enrollment ID | O20221214001352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043928476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Simon M Sheard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083926877 PECOS PAC ID: 4385883495 Enrollment ID: I20130621000388 |
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