| Ocotillo Family Medicine, Pllc | |
|
16515 S 40th St Suite 109 Phoenix AZ 85048-0558 | |
| (480) 706-0174 | |
| Not Available |
| Full Name | Ocotillo Family Medicine, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 16515 S 40th St, Phoenix, Arizona |
| Authorized Official Name and Position | Gil Holland (OWNER) |
| Authorized Official Contact | 4807060174 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ocotillo Family Medicine, Pllc 16515 S 40th St Suite 109 Phoenix AZ 85048-0558 Ph: (480) 706-0174 | Ocotillo Family Medicine, Pllc 16515 S 40th St Suite 109 Phoenix AZ 85048-0558 Ph: (480) 706-0174 |
| NPI Number | 1982668935 |
|---|---|
| Provider Enumeration Date | 04/14/2006 |
| Last Update Date | 10/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982668935 | NPI | - | NPPES |
| 522104 | Medicaid | AZ | |
| 776130 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 31233 (Arizona) | Primary |
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