| Gp Medicine, Pllc | |
|
1800 E Wilcox Drive Sierra Vista AZ 85635 | |
| (520) 459-3116 | |
| (520) 459-7397 |
| Full Name | Gp Medicine, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1800 E Wilcox Drive, Sierra Vista, Arizona |
| Authorized Official Name and Position | Philip M Lesueur (MEDICAL DIRECTOR) |
| Authorized Official Contact | 5204593116 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gp Medicine, Pllc 1800 E Wilcox Drive Sierra Vista AZ 85635 Ph: (520) 459-3116 | Gp Medicine, Pllc 1800 E Wilcox Drive Sierra Vista AZ 85635 Ph: (520) 459-3116 |
| NPI Number | 1568001543 |
|---|---|
| Provider Enumeration Date | 12/23/2019 |
| Last Update Date | 12/23/2019 |
| Medicare PECOS PAC ID | 6800216672 |
|---|---|
| Medicare Enrollment ID | O20201015002751 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568001543 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ralph E Mayberry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063487486 PECOS PAC ID: 2163470931 Enrollment ID: I20050107000747 |
| Provider Name | Pamela G Enright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548436603 PECOS PAC ID: 9436210317 Enrollment ID: I20081210000703 |
| Provider Name | Garrick L Haymore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972978328 PECOS PAC ID: 2062714702 Enrollment ID: I20160112001704 |
| Provider Name | Philip M Lesueur |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194161505 PECOS PAC ID: 9234416561 Enrollment ID: I20170515001296 |
| Provider Name | Matthew Robert Genz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316471683 PECOS PAC ID: 4981971967 Enrollment ID: I20170523000259 |
| Provider Name | Jason Patrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730705377 PECOS PAC ID: 3870918519 Enrollment ID: I20200904001013 |
| Provider Name | Danielle Nicole Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023697828 PECOS PAC ID: 9436556297 Enrollment ID: I20210921001434 |
| Provider Name | Kendie Sue Tilden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871371484 PECOS PAC ID: 2668818287 Enrollment ID: I20240306000868 |
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