| Desert Spurs Primary Care, Pllc | |
|
1355 Ramar Rd Ste. 10 Bullhead City AZ 86442-7100 | |
| (928) 444-8405 | |
| (928) 299-5300 |
| Full Name | Desert Spurs Primary Care, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1355 Ramar Rd, Bullhead City, Arizona |
| Authorized Official Name and Position | Robert J Bazaco (OWNER) |
| Authorized Official Contact | 2104648311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Spurs Primary Care, Pllc 251 Moser Ave Apt. 105 Bullhead City AZ 86429-5240 Ph: (210) 464-8311 | Desert Spurs Primary Care, Pllc 1355 Ramar Rd Ste. 10 Bullhead City AZ 86442-7100 Ph: (928) 444-8405 |
| NPI Number | 1730634965 |
|---|---|
| Provider Enumeration Date | 08/17/2016 |
| Last Update Date | 08/17/2016 |
| Medicare PECOS PAC ID | 7911295670 |
|---|---|
| Medicare Enrollment ID | O20161012000952 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730634965 | NPI | - | NPPES |
| P20970983 | Other | AZ | CORPORATION ID# |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 48283 (Arizona) | Primary |
| Provider Name | Robert J Bazaco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487931770 PECOS PAC ID: 7315174307 Enrollment ID: I20131219000528 |
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