| Grand Canyon University | |
|
3300 W Camelback Rd Health Center Phoenix AZ 85017-1097 | |
| (602) 639-6215 | |
| (602) 639-7830 |
| Full Name | Grand Canyon University |
|---|---|
| Speciality | Family Medicine |
| Location | 3300 W Camelback Rd, Phoenix, Arizona |
| Authorized Official Name and Position | Constance Colbert (DIRECTOR) |
| Authorized Official Contact | 6026397757 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Canyon University 3300 W Camelback Rd Health Center Phoenix AZ 85017-1097 Ph: (602) 639-6215 | Grand Canyon University 3300 W Camelback Rd Health Center Phoenix AZ 85017-1097 Ph: (602) 639-6215 |
| NPI Number | 1124501069 |
|---|---|
| Provider Enumeration Date | 09/06/2018 |
| Last Update Date | 02/06/2021 |
| Medicare PECOS PAC ID | 9537577499 |
|---|---|
| Medicare Enrollment ID | O20210415000091 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124501069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OTC9096 (Arizona) | Primary |
| Provider Name | Tamara N Wisely |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801918883 PECOS PAC ID: 2567524739 Enrollment ID: I20081222000541 |
| Provider Name | Constance R Colbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205083839 PECOS PAC ID: 6103974316 Enrollment ID: I20090428000112 |
| Provider Name | Matthew D Shores |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861513889 PECOS PAC ID: 0042356982 Enrollment ID: I20091007000583 |
| Provider Name | Lyndee A Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285989608 PECOS PAC ID: 1759530751 Enrollment ID: I20121008000487 |
| Provider Name | Cyndirae Braun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508293903 PECOS PAC ID: 2567688385 Enrollment ID: I20140919002274 |
| Provider Name | Heather A Healy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669493771 PECOS PAC ID: 8628073921 Enrollment ID: I20160914000346 |
| Provider Name | Lily Anna Limon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841761434 PECOS PAC ID: 9436567278 Enrollment ID: I20210416000726 |
| Provider Name | Bethany Whitson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477052876 PECOS PAC ID: 0648688127 Enrollment ID: I20210422000035 |
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