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515 S Stanfield Rd Bldg O Stanfield AZ 85172-9687 | |
(520) 387-5651 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 515 S Stanfield Rd Bldg O, Stanfield, Arizona |
Authorized Official Name and Position | Daniel Barbara (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5203875651 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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410 N Malacate St Ajo AZ 85321-2254 Ph: (509) 261-8090 | 515 S Stanfield Rd Bldg O Stanfield AZ 85172-9687 Ph: (520) 387-5651 |
NPI Number | 1932974672 |
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Provider Enumeration Date | 11/22/2023 |
Last Update Date | 01/08/2024 |
Medicare PECOS PAC ID | 3476441866 |
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Medicare Enrollment ID | O20241017001319 |
Identifier | Type | State | Issuer |
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1932974672 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |