| |
2221 E Frontage Rd Ste 101 Bldg G-ste 101/bldg F-ste 104 Tubac AZ 85646-9997 | |
(520) 281-1550 | |
(520) 281-4487 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 2221 E Frontage Rd Ste 101, Tubac, Arizona |
Authorized Official Name and Position | Daniel Prevost (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5207612128 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
825 N Grand Ave Ste 100 Nogales AZ 85621-2385 Ph: (520) 761-2128 | 2221 E Frontage Rd Ste 101 Bldg G-ste 101/bldg F-ste 104 Tubac AZ 85646-9997 Ph: (520) 281-1550 |
NPI Number | 1578922787 |
---|---|
Provider Enumeration Date | 02/16/2016 |
Last Update Date | 01/17/2024 |
Medicare PECOS PAC ID | 8123926326 |
---|---|
Medicare Enrollment ID | O20160907003082 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578922787 | NPI | - | NPPES |
156624 | Medicaid | AZ | |
ZFQ31812 | Other | AZ | MEDICARE PART B GROUP# |