| Manzanita Medical Pllc | |
|
4545 E Shea Blvd Ste 130 Phoenix AZ 85028-3061 | |
| (480) 292-9532 | |
| (480) 664-3482 |
| Full Name | Manzanita Medical Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 4545 E Shea Blvd Ste 130, Phoenix, Arizona |
| Authorized Official Name and Position | Judith Hallas (OFFICE MANAGER) |
| Authorized Official Contact | 4802929532 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manzanita Medical Pllc 4545 E Shea Blvd Ste 130 Phoenix AZ 85028-3061 Ph: (480) 292-9532 | Manzanita Medical Pllc 4545 E Shea Blvd Ste 130 Phoenix AZ 85028-3061 Ph: (480) 292-9532 |
| NPI Number | 1306376611 |
|---|---|
| Provider Enumeration Date | 06/19/2017 |
| Last Update Date | 07/23/2024 |
| Medicare PECOS PAC ID | 6608147574 |
|---|---|
| Medicare Enrollment ID | O20170810003206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306376611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Arizona) | Primary |
| Provider Name | Shayna M Mansfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780687087 PECOS PAC ID: 6204803380 Enrollment ID: I20040916001052 |
| Provider Name | Mayy S Deadrick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194741074 PECOS PAC ID: 3476449869 Enrollment ID: I20100305000250 |
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