| |
9700 N Saguaro Blvd Ste 100 Fountain Hls AZ 85268-6242 | |
(602) 671-7981 | |
(602) 755-0457 |
Full Name | |
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Speciality | Family Medicine |
Location | 9700 N Saguaro Blvd Ste 100, Fountain Hls, Arizona |
Authorized Official Name and Position | Chukwuemeka Ezeume (PRESIDENT / CEO) |
Authorized Official Contact | 6026717981 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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9700 N Saguaro Blvd Ste 100 Fountain Hills AZ 85268-6242 Ph: (602) 671-7981 | 9700 N Saguaro Blvd Ste 100 Fountain Hls AZ 85268-6242 Ph: (602) 671-7981 |
NPI Number | 1295355881 |
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Provider Enumeration Date | 04/23/2020 |
Last Update Date | 11/21/2023 |
Medicare PECOS PAC ID | 2961818976 |
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Medicare Enrollment ID | O20210416001675 |
Identifier | Type | State | Issuer |
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1295355881 | NPI | - | NPPES |
082025 | Medicaid | AZ |
Provider Name | Chukwuemeka Ezeume |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1629361340 PECOS PAC ID: 9830318088 Enrollment ID: I20180413002147 |
Provider Name | Oluchi Ezeume |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295138246 PECOS PAC ID: 4183946122 Enrollment ID: I20210416001504 |
Provider Name | Debra L Palka |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730867946 PECOS PAC ID: 8628417441 Enrollment ID: I20240412002620 |