| Grace Medical Group Llc | |
|
2675 N Wyatt Dr Tucson AZ 85712-6107 | |
| (520) 260-0937 | |
| (520) 320-0688 |
| Full Name | Grace Medical Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2675 N Wyatt Dr, Tucson, Arizona |
| Authorized Official Name and Position | William Douglas Martz (OWNER/CEO) |
| Authorized Official Contact | 5202600937 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Medical Group Llc 2675 N Wyatt Dr Tucson AZ 85712-6107 Ph: (520) 260-0937 | Grace Medical Group Llc 2675 N Wyatt Dr Tucson AZ 85712-6107 Ph: (520) 260-0937 |
| NPI Number | 1215603964 |
|---|---|
| Provider Enumeration Date | 08/20/2021 |
| Last Update Date | 08/20/2021 |
| Medicare PECOS PAC ID | 7012306624 |
|---|---|
| Medicare Enrollment ID | O20211118003211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215603964 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Vicky R Norwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679594196 PECOS PAC ID: 5799682860 Enrollment ID: I20031217000086 |
| Provider Name | William D Martz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215950027 PECOS PAC ID: 7517906217 Enrollment ID: I20050502001282 |
| Provider Name | Cecilia A Amanti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659303162 PECOS PAC ID: 5294748711 Enrollment ID: I20060728000060 |
| Provider Name | Janet G Chapman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750619276 PECOS PAC ID: 1254468887 Enrollment ID: I20100429000947 |
| Provider Name | Khalid M Shirif |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1407927130 PECOS PAC ID: 7517099807 Enrollment ID: I20100722000399 |
| Provider Name | Heidi S Montague |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316033103 PECOS PAC ID: 4486749710 Enrollment ID: I20121022000482 |
| Provider Name | Kimberley S Fahle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356052161 PECOS PAC ID: 7618323882 Enrollment ID: I20231024002032 |
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