| Great Tower Recovery, Llc | |
|
5501 N 19th Ave Ste 331 Phoenix AZ 85015-2455 | |
| (480) 262-4547 | |
| Not Available |
| Full Name | Great Tower Recovery, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5501 N 19th Ave Ste 331, Phoenix, Arizona |
| Authorized Official Name and Position | Ifiok Umoren (CO-OWNER) |
| Authorized Official Contact | 4802624547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Tower Recovery, Llc 31925 N 125th Ave Peoria AZ 85383-5675 Ph: () - | Great Tower Recovery, Llc 5501 N 19th Ave Ste 331 Phoenix AZ 85015-2455 Ph: (480) 262-4547 |
| NPI Number | 1831801232 |
|---|---|
| Provider Enumeration Date | 12/16/2022 |
| Last Update Date | 12/16/2022 |
| Medicare PECOS PAC ID | 3274073523 |
|---|---|
| Medicare Enrollment ID | O20240912003318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831801232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Kingsley Eboru |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336916105 PECOS PAC ID: 6901257245 Enrollment ID: I20240110004529 |
| Provider Name | Felicia Ugborugbo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902685993 PECOS PAC ID: 8325482789 Enrollment ID: I20240214001047 |
| Provider Name | Marshall E Umoren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982105334 PECOS PAC ID: 7719427061 Enrollment ID: I20240912003463 |
| Provider Name | Ugochi Mary Diokpa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770321655 PECOS PAC ID: 4880135821 Enrollment ID: I20240918002187 |
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