Leading Edge Medical | |
1530 S Val Vista Dr Ste 106 Gilbert AZ 85296-3860 | |
(480) 664-6061 | |
(480) 584-6336 |
Full Name | Leading Edge Medical |
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Speciality | General Practice |
Location | 1530 S Val Vista Dr Ste 106, Gilbert, Arizona |
Authorized Official Name and Position | Benjamin Johnson (OWNER) |
Authorized Official Contact | 4806646061 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Leading Edge Medical 1530 S Val Vista Dr Ste 106 Gilbert AZ 85296-3860 Ph: (480) 664-6061 | Leading Edge Medical 1530 S Val Vista Dr Ste 106 Gilbert AZ 85296-3860 Ph: (480) 664-6061 |
NPI Number | 1861915688 |
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Provider Enumeration Date | 07/24/2017 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 8224396874 |
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Medicare Enrollment ID | O20180103001758 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861915688 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Ben Johnson |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1609029057 PECOS PAC ID: 6305998667 Enrollment ID: I20090716000660 |
Provider Name | Samantha Nazaroff |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467975698 PECOS PAC ID: 0345507844 Enrollment ID: I20171207001474 |
Provider Name | Tammatha L Jones |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1417439274 PECOS PAC ID: 0547505984 Enrollment ID: I20181213000553 |
Provider Name | Samantha Jo Christman |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033799465 PECOS PAC ID: 4688066970 Enrollment ID: I20220118002665 |
Provider Name | Ashley Ann Foster |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1235883935 PECOS PAC ID: 4486036217 Enrollment ID: I20220727003173 |
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