| Fala Medical Clinic Pllc | |
|
14749 W Mountain View Blvd Ste 138 Surprise AZ 85374-2704 | |
| (623) 738-0440 | |
| (480) 374-8051 |
| Full Name | Fala Medical Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14749 W Mountain View Blvd Ste 138, Surprise, Arizona |
| Authorized Official Name and Position | Freschta Mirzakhel (PRACTICE ADMINISITRATOR) |
| Authorized Official Contact | 4802588264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fala Medical Clinic Pllc 14749 W Mountain View Blvd Ste 138 Surprise AZ 85374-2704 Ph: (623) 738-0440 | Fala Medical Clinic Pllc 14749 W Mountain View Blvd Ste 138 Surprise AZ 85374-2704 Ph: (623) 738-0440 |
| NPI Number | 1972134054 |
|---|---|
| Provider Enumeration Date | 01/28/2020 |
| Last Update Date | 05/08/2023 |
| Medicare PECOS PAC ID | 9931524527 |
|---|---|
| Medicare Enrollment ID | O20200729003115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972134054 | NPI | - | NPPES |
| 546663 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Hamidullah H Fala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124284625 PECOS PAC ID: 0345435814 Enrollment ID: I20101110000056 |
| Provider Name | Bridget N Mackie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023570207 PECOS PAC ID: 8123354891 Enrollment ID: I20190801003413 |
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