| Na | |
|
2078 Willow Creek Rd Prescott AZ 86301-5389 | |
| (928) 776-6400 | |
| (855) 633-3142 |
| Full Name | Na |
|---|---|
| Speciality | Family Medicine |
| Location | 2078 Willow Creek Rd, Prescott, Arizona |
| Authorized Official Name and Position | Josh Baker (PRACTICE MANAGER) |
| Authorized Official Contact | 9287766400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Na 2078 Willow Creek Rd Prescott AZ 86301-5389 Ph: (928) 776-6400 | Na 2078 Willow Creek Rd Prescott AZ 86301-5389 Ph: (928) 776-6400 |
| NPI Number | 1770732307 |
|---|---|
| Provider Enumeration Date | 09/18/2008 |
| Last Update Date | 04/12/2023 |
| Medicare PECOS PAC ID | 8123186939 |
|---|---|
| Medicare Enrollment ID | O20081023000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770732307 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 3779 (Arizona) | Primary |
| Provider Name | Brett A Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730380908 PECOS PAC ID: 3173690476 Enrollment ID: I20080929000703 |
| Provider Name | William F Devito |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073559738 PECOS PAC ID: 3870651672 Enrollment ID: I20081023000274 |
| Provider Name | Dennis Lanier Little |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801832563 PECOS PAC ID: 8325224934 Enrollment ID: I20110517000161 |
| Provider Name | Denise Lorene Mcmurphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972062719 PECOS PAC ID: 3072946946 Enrollment ID: I20191206000951 |
| Provider Name | Kelli B Folgheraiter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942973656 PECOS PAC ID: 9931504404 Enrollment ID: I20210826003111 |
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