Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 227 Main St., Duncan, Arizona |
Authorized Official Name and Position | Christopher Hansen (CEO) |
Authorized Official Contact | 9286459675 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1625 Page AZ 86040-1625 Ph: (928) 645-9675 | 227 Main St. Duncan AZ 85534 Ph: (928) 359-1380 |
NPI Number | 1033275706 |
---|---|
Provider Enumeration Date | 12/28/2006 |
Last Update Date | 03/20/2023 |
Medicare PECOS PAC ID | 4082509591 |
---|---|
Medicare Enrollment ID | O20071127000636 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033275706 | NPI | - | NPPES |
933609 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | OTC 4096 (Arizona) | Primary |