| Enroute Provider Services Llc | |
|
17505 N 79th Ave Ste 313a Glendale AZ 85308-8730 | |
| (623) 225-5875 | |
| Not Available |
| Full Name | Enroute Provider Services Llc |
|---|---|
| Speciality | General Practice |
| Location | 17505 N 79th Ave Ste 313a, Glendale, Arizona |
| Authorized Official Name and Position | Dunedin Hervias (FOUNDER) |
| Authorized Official Contact | 6232255875 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enroute Provider Services Llc 17505 N 79th Ave Ste 313a Glendale AZ 85308-8730 Ph: (623) 225-5875 | Enroute Provider Services Llc 17505 N 79th Ave Ste 313a Glendale AZ 85308-8730 Ph: (623) 225-5875 |
| NPI Number | 1285485920 |
|---|---|
| Provider Enumeration Date | 04/01/2024 |
| Last Update Date | 06/20/2024 |
| Medicare PECOS PAC ID | 8820430523 |
|---|---|
| Medicare Enrollment ID | O20240528000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285485920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Secondary |
| Provider Name | William H Mcginnis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275591612 PECOS PAC ID: 5698708683 Enrollment ID: I20050912000054 |
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