| Na | |
|
4828 S Val Vista Dr Gilbert AZ 85298-7323 | |
| (480) 802-9977 | |
| Not Available |
| Full Name | Na |
|---|---|
| Speciality | General Practice |
| Location | 4828 S Val Vista Dr, Gilbert, Arizona |
| Authorized Official Name and Position | Sarah Holewinski (CEO) |
| Authorized Official Contact | 4804768503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Na 4828 S Val Vista Dr Gilbert AZ 85298-7323 Ph: (480) 802-9977 | Na 4828 S Val Vista Dr Gilbert AZ 85298-7323 Ph: (480) 802-9977 |
| NPI Number | 1669970562 |
|---|---|
| Provider Enumeration Date | 01/25/2018 |
| Last Update Date | 10/04/2021 |
| Medicare PECOS PAC ID | 8426310285 |
|---|---|
| Medicare Enrollment ID | O20180315001087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669970562 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | James O Holloway |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1548696164 PECOS PAC ID: 3375979941 Enrollment ID: I20200130002824 |
| Provider Name | Ekaterina Erev |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841878451 PECOS PAC ID: 2567871486 Enrollment ID: I20210505002870 |
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