Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 47 6th Ave, Page, Arizona |
Authorized Official Name and Position | Lee Johnson (TREASURER) |
Authorized Official Contact | 2084011369 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
47 6th Ave Page AZ 86040-0470 Ph: (928) 645-0366 | 47 6th Ave Page AZ 86040-0470 Ph: (928) 645-0366 |
NPI Number | 1891311171 |
---|---|
Provider Enumeration Date | 06/22/2020 |
Last Update Date | 03/16/2021 |
Medicare PECOS PAC ID | 6305260829 |
---|---|
Medicare Enrollment ID | O20200716003136 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891311171 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Shauna H Simpson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114363009 PECOS PAC ID: 6901031277 Enrollment ID: I20160721002327 |
Provider Name | Terry Kulia Stevenson |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1184610800 PECOS PAC ID: 4981036746 Enrollment ID: I20191115001438 |
Provider Name | Marsha Landvatter |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1053809343 PECOS PAC ID: 9335478288 Enrollment ID: I20201008001914 |
Provider Name | Lea S Jerpseth |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205403508 PECOS PAC ID: 6305984998 Enrollment ID: I20210805003713 |
Provider Name | Valarie Ann Karr |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497594238 PECOS PAC ID: 9739621533 Enrollment ID: I20240607002761 |
Provider Name | Michelle Johnson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538936745 PECOS PAC ID: 9931551884 Enrollment ID: I20240619001377 |
Provider Name | Susan Varner |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639199615 PECOS PAC ID: 6002812179 Enrollment ID: I20241011000658 |
Provider Name | Mauricio Palacios Romero |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114747524 PECOS PAC ID: 7517499205 Enrollment ID: I20241018003520 |
Provider Name | Danielle Schneeweis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942067004 PECOS PAC ID: 6305095050 Enrollment ID: I20241125004154 |
Banner Hospital Based Physicians Arizona Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 N Navajo, Page, AZ 86040 Phone: 928-645-0112 | |
Banner Physician Specialists Arizona Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 N Navajo, Page, AZ 86040 Phone: 928-645-0131 Fax: 928-645-3549 | |
Banner - University Physician Specialists Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 N Navajo Dr, Page, AZ 86040 Phone: 928-645-0131 Fax: 928-645-3549 | |
Canyonlands Community Health Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 635 Elm Street, #9, Page, AZ 86040 Phone: 928-645-8864 |