| Madison Medical Partners, Llc | |
|
911 W Las Palmaritas Dr Phoenix AZ 85021-5546 | |
| (602) 505-0667 | |
| Not Available |
| Full Name | Madison Medical Partners, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 911 W Las Palmaritas Dr, Phoenix, Arizona |
| Authorized Official Name and Position | Matthew Shores (PARTNER) |
| Authorized Official Contact | 4804149868 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Medical Partners, Llc 911 W Las Palmaritas Dr Phoenix AZ 85021-5546 Ph: () - | Madison Medical Partners, Llc 911 W Las Palmaritas Dr Phoenix AZ 85021-5546 Ph: (602) 505-0667 |
| NPI Number | 1730790080 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 08/11/2020 |
| Medicare PECOS PAC ID | 9931529302 |
|---|---|
| Medicare Enrollment ID | O20201023001753 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730790080 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Matthew D Shores |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861513889 PECOS PAC ID: 0042356982 Enrollment ID: I20091007000583 |
| Provider Name | Jenny R Khan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487824322 PECOS PAC ID: 6406981885 Enrollment ID: I20100324000545 |
| Provider Name | Lyndee A Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285989608 PECOS PAC ID: 1759530751 Enrollment ID: I20121008000487 |
| Provider Name | John Risi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932623469 PECOS PAC ID: 4385918283 Enrollment ID: I20171128002949 |
| Provider Name | Troy Lance Passmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528561016 PECOS PAC ID: 7012257488 Enrollment ID: I20190321000590 |
| Provider Name | Loren A Lawrence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487136685 PECOS PAC ID: 0143556407 Enrollment ID: I20190724000990 |
| Provider Name | Keri J Griffith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104295195 PECOS PAC ID: 3678854361 Enrollment ID: I20201015000830 |
| Provider Name | Brittany Netto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659717197 PECOS PAC ID: 6507093937 Enrollment ID: I20210811003718 |
| Provider Name | Randall Beaupre |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1457883811 PECOS PAC ID: 7618351354 Enrollment ID: I20230209000803 |
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