| Peach Springs Health Center | |
|
943 Hualapai Way Peach Springs AZ 86434-0190 | |
| (928) 769-2900 | |
| (928) 769-2701 |
| Full Name | Peach Springs Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 943 Hualapai Way, Peach Springs, Arizona |
| Authorized Official Name and Position | Lisa R Chamberlain (PATIENT BUSINESS OFFICE) |
| Authorized Official Contact | 9287692918 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peach Springs Health Center Po Box 190 Peach Springs AZ 86434-0190 Ph: (928) 769-2900 | Peach Springs Health Center 943 Hualapai Way Peach Springs AZ 86434-0190 Ph: (928) 769-2900 |
| NPI Number | 1265719934 |
|---|---|
| Provider Enumeration Date | 11/09/2011 |
| Last Update Date | 12/12/2022 |
| Medicare PECOS PAC ID | 7810163011 |
|---|---|
| Medicare Enrollment ID | O20120109000961 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265719934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Glen Y Kishi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1174561765 PECOS PAC ID: 6305741448 Enrollment ID: I20031203000211 |
| Provider Name | Kenneth J Westrate |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568564326 PECOS PAC ID: 2365340510 Enrollment ID: I20031223000862 |
| Provider Name | Richard T Caldwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952392532 PECOS PAC ID: 0143294785 Enrollment ID: I20040820000546 |
| Provider Name | Julia B Talboys |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194753368 PECOS PAC ID: 4385605500 Enrollment ID: I20041021000386 |
| Provider Name | Roland A Palmquist |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1750301545 PECOS PAC ID: 9931165347 Enrollment ID: I20041207001246 |
| Provider Name | Steven C White |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174529507 PECOS PAC ID: 3375595846 Enrollment ID: I20050211000808 |
| Provider Name | William L Yeaton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053419242 PECOS PAC ID: 0042254476 Enrollment ID: I20050615001078 |
| Provider Name | Jerold R Morgan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710910575 PECOS PAC ID: 9032134200 Enrollment ID: I20051007000217 |
| Provider Name | Kristen R Burkholder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083795108 PECOS PAC ID: 4981626553 Enrollment ID: I20051222000638 |
| Provider Name | Henry Mack Owen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962526988 PECOS PAC ID: 5092737981 Enrollment ID: I20060307000787 |
| Provider Name | Mark G Peterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629129168 PECOS PAC ID: 2466469341 Enrollment ID: I20060317000296 |
| Provider Name | Thomas M Kessler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578590279 PECOS PAC ID: 3476550393 Enrollment ID: I20061106000558 |
| Provider Name | Lilly M Shimahara |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1184735920 PECOS PAC ID: 4284657693 Enrollment ID: I20070803000155 |
| Provider Name | Anthony Vincent Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811074834 PECOS PAC ID: 9032214911 Enrollment ID: I20071019000478 |
| Provider Name | Criselle Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366517385 PECOS PAC ID: 4981656899 Enrollment ID: I20080225000741 |
| Provider Name | Robert L Kesead |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1003879123 PECOS PAC ID: 7911085303 Enrollment ID: I20080425000254 |
| Provider Name | Geniel Harrison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528243805 PECOS PAC ID: 5092876532 Enrollment ID: I20081203000161 |
| Provider Name | Christian J Ingui |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407893894 PECOS PAC ID: 0042213431 Enrollment ID: I20081203000324 |
| Provider Name | Ari D Plosker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639141682 PECOS PAC ID: 4587693320 Enrollment ID: I20081203000368 |
| Provider Name | Owen B Gilmore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194727198 PECOS PAC ID: 7315955846 Enrollment ID: I20090116000129 |
| Provider Name | Cynthia A Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427295732 PECOS PAC ID: 5092860254 Enrollment ID: I20090911000457 |
| Provider Name | Kevin A Rodgers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720014434 PECOS PAC ID: 5698784817 Enrollment ID: I20100226000213 |
| Provider Name | Emily Jane Tatum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760565279 PECOS PAC ID: 3274614383 Enrollment ID: I20100709000084 |
| Provider Name | Alexander Matthews |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649395039 PECOS PAC ID: 9234322058 Enrollment ID: I20110218000066 |
| Provider Name | Brian F Hanley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467657841 PECOS PAC ID: 1355511924 Enrollment ID: I20110909002578 |
| Provider Name | Melvin J Clark |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1093704751 PECOS PAC ID: 2860388303 Enrollment ID: I20111024000719 |
| Provider Name | Dianna L Mahoney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649372004 PECOS PAC ID: 4486828050 Enrollment ID: I20111116000418 |
| Provider Name | Kevin A Skinner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013997881 PECOS PAC ID: 9739138785 Enrollment ID: I20120209000284 |
| Provider Name | Kevin D Burns |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588898712 PECOS PAC ID: 2163671074 Enrollment ID: I20121010000210 |
| Provider Name | James N Danielson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1306886676 PECOS PAC ID: 4385630813 Enrollment ID: I20140127001037 |
| Provider Name | Huma S Qureshi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568447357 PECOS PAC ID: 9335167733 Enrollment ID: I20140212000771 |
| Provider Name | Nicolaus J Kuehn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518946649 PECOS PAC ID: 6507858651 Enrollment ID: I20140228000613 |
| Provider Name | Vickie P Clennon |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578771952 PECOS PAC ID: 6103908470 Enrollment ID: I20140304001764 |
| Provider Name | Kamiar Massrour |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376791343 PECOS PAC ID: 4587704119 Enrollment ID: I20140310001736 |
| Provider Name | David Wells |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659447118 PECOS PAC ID: 0143128082 Enrollment ID: I20140313000790 |
| Provider Name | Mark E Mering |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578527990 PECOS PAC ID: 8022921303 Enrollment ID: I20140417001713 |
| Provider Name | Jeffrey Caverly |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912968686 PECOS PAC ID: 2961509500 Enrollment ID: I20140522002123 |
| Provider Name | Peilin Reed |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265484794 PECOS PAC ID: 5991783227 Enrollment ID: I20140602001890 |
| Provider Name | David J Kersbergen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497745525 PECOS PAC ID: 1951524313 Enrollment ID: I20140603002268 |
| Provider Name | Sarah John |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1518142470 PECOS PAC ID: 5698853547 Enrollment ID: I20140605000282 |
| Provider Name | Forrest J King |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003101288 PECOS PAC ID: 3274757281 Enrollment ID: I20140613000864 |
| Provider Name | Aaron Jun |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033194253 PECOS PAC ID: 5496773061 Enrollment ID: I20140626000838 |
| Provider Name | Jose A Ospina |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033373287 PECOS PAC ID: 7618147653 Enrollment ID: I20140626002168 |
| Provider Name | Michael E Day |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245275213 PECOS PAC ID: 0143289462 Enrollment ID: I20140806000119 |
| Provider Name | Pamela E Stewart |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255397253 PECOS PAC ID: 7719921642 Enrollment ID: I20141105001807 |
| Provider Name | Deborah Cornell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801824586 PECOS PAC ID: 4880752534 Enrollment ID: I20141223000823 |
| Provider Name | Lance Mcadams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497089205 PECOS PAC ID: 5991028730 Enrollment ID: I20141230002145 |
| Provider Name | Kristi A Petersen |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1548515406 PECOS PAC ID: 2365671583 Enrollment ID: I20150102000288 |
| Provider Name | Roger V Cox |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1104038488 PECOS PAC ID: 2668646068 Enrollment ID: I20150105001861 |
| Provider Name | Jonathan Franco |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1699736371 PECOS PAC ID: 6507820537 Enrollment ID: I20150115002134 |
| Provider Name | Randall Lee Oliver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356393219 PECOS PAC ID: 3870407232 Enrollment ID: I20150212000200 |
| Provider Name | Susan L Pinsky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801851530 PECOS PAC ID: 4486842200 Enrollment ID: I20150325002352 |
| Provider Name | Marcia Oliver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396722849 PECOS PAC ID: 1254592892 Enrollment ID: I20150415001022 |
| Provider Name | Peter W Bauer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922004910 PECOS PAC ID: 7012052061 Enrollment ID: I20150421001277 |
| Provider Name | Angela Mosby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235118233 PECOS PAC ID: 7315943412 Enrollment ID: I20150424000561 |
| Provider Name | Paul S Weinberg |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609804426 PECOS PAC ID: 8022036045 Enrollment ID: I20150424000568 |
| Provider Name | Dara L Shahon |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1649300211 PECOS PAC ID: 3476588351 Enrollment ID: I20150813010889 |
| Provider Name | Tina Pattara-lau |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1467748319 PECOS PAC ID: 4284941584 Enrollment ID: I20150918002103 |
| Provider Name | Ronald A Zent |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932273919 PECOS PAC ID: 4385634211 Enrollment ID: I20150922002363 |
| Provider Name | Jonathan E Bishop |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962426981 PECOS PAC ID: 0345229811 Enrollment ID: I20151208003102 |
| Provider Name | Theresa E Towle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639486137 PECOS PAC ID: 0648468207 Enrollment ID: I20151209000511 |
| Provider Name | Alan S Berman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396773636 PECOS PAC ID: 5496722696 Enrollment ID: I20151229002492 |
| Provider Name | Perry D Guthrie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477939882 PECOS PAC ID: 1254634850 Enrollment ID: I20160114000824 |
| Provider Name | Thomas H Bigham |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1689642332 PECOS PAC ID: 6204826902 Enrollment ID: I20160122001774 |
| Provider Name | Luna Amelingmeier |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1265839633 PECOS PAC ID: 3072817220 Enrollment ID: I20160208001957 |
| Provider Name | Esperanza Flores |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467470112 PECOS PAC ID: 2961483342 Enrollment ID: I20160217001092 |
| Provider Name | Dwight E Burdick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801201496 PECOS PAC ID: 3971808213 Enrollment ID: I20160224000353 |
| Provider Name | Rene Gonzalez Garcia |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1639269913 PECOS PAC ID: 5395762702 Enrollment ID: I20160314002435 |
| Provider Name | John R Bennett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558385666 PECOS PAC ID: 7012905177 Enrollment ID: I20160401001121 |
| Provider Name | Amy Lebbon |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1760887087 PECOS PAC ID: 2860781127 Enrollment ID: I20160510001922 |
| Provider Name | Dwala M Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346628088 PECOS PAC ID: 3274822630 Enrollment ID: I20160525001521 |
| Provider Name | Surender Kurapati |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073558383 PECOS PAC ID: 8628982428 Enrollment ID: I20160714001549 |
| Provider Name | Scottie A Bussell |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1003196429 PECOS PAC ID: 4688968969 Enrollment ID: I20160809002483 |
| Provider Name | David L Hanson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1366649980 PECOS PAC ID: 4981991387 Enrollment ID: I20160929000302 |
| Provider Name | Juli M Haws |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1316264856 PECOS PAC ID: 9335437763 Enrollment ID: I20161018000416 |
| Provider Name | Kelly A Cricks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346501012 PECOS PAC ID: 9133439144 Enrollment ID: I20161029000047 |
| Provider Name | Rishi Patel |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1154797165 PECOS PAC ID: 9739468604 Enrollment ID: I20161116002196 |
| Provider Name | Virgilio A Cantu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437184686 PECOS PAC ID: 0042279671 Enrollment ID: I20161118001141 |
| Provider Name | Moses B Benavides |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326332768 PECOS PAC ID: 1254623549 Enrollment ID: I20161130001914 |
| Provider Name | Cheri J Diller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447250774 PECOS PAC ID: 5597783183 Enrollment ID: I20161215000971 |
| Provider Name | Lorrie A White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679880876 PECOS PAC ID: 1456583806 Enrollment ID: I20161229000245 |
| Provider Name | Christine L Kramer |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1285719351 PECOS PAC ID: 3173568359 Enrollment ID: I20170220002654 |
| Provider Name | Eric Simball |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720043805 PECOS PAC ID: 1153470406 Enrollment ID: I20170301000432 |
| Provider Name | Alexander Brazalovich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295787133 PECOS PAC ID: 4688604630 Enrollment ID: I20170330002410 |
| Provider Name | Tahir Alkhairy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023026234 PECOS PAC ID: 8527960434 Enrollment ID: I20170508002146 |
| Provider Name | Brett T Mumford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164463113 PECOS PAC ID: 4880592112 Enrollment ID: I20170720000018 |
| Provider Name | Charles M Davis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447240171 PECOS PAC ID: 9335230291 Enrollment ID: I20170825001969 |
| Provider Name | Adrian A Cordovi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407084353 PECOS PAC ID: 6901921121 Enrollment ID: I20170919000534 |
| Provider Name | Keith G Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437225786 PECOS PAC ID: 8123051877 Enrollment ID: I20180209000227 |
| Provider Name | Brian A Bonnyman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871505685 PECOS PAC ID: 5799881546 Enrollment ID: I20180222001765 |
| Provider Name | Pierre Lanthiez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801864970 PECOS PAC ID: 2769570860 Enrollment ID: I20180319000669 |
| Provider Name | Cody Martin Knuppenburg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760898563 PECOS PAC ID: 0840510483 Enrollment ID: I20180322000797 |
| Provider Name | Esker M Arvanetes Ellis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073625547 PECOS PAC ID: 6507024924 Enrollment ID: I20180322001449 |
| Provider Name | Nancy R Sagona |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1679574461 PECOS PAC ID: 9537148762 Enrollment ID: I20180502001119 |
| Provider Name | Robin L Lowenthal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265587653 PECOS PAC ID: 2062538911 Enrollment ID: I20180608001407 |
| Provider Name | Jaime D Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386978427 PECOS PAC ID: 2062694730 Enrollment ID: I20180731000399 |
| Provider Name | George C Wortley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932108933 PECOS PAC ID: 1456373661 Enrollment ID: I20180921000328 |
| Provider Name | Rajni Gunnala |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1881091361 PECOS PAC ID: 1557671187 Enrollment ID: I20190123000406 |
| Provider Name | Daniel N Lucas |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417905522 PECOS PAC ID: 8527040195 Enrollment ID: I20190502000487 |
| Provider Name | Ann Diamond |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033137385 PECOS PAC ID: 5092786418 Enrollment ID: I20190913000283 |
| Provider Name | Michelle F Dubuisson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043723745 PECOS PAC ID: 6103155304 Enrollment ID: I20190913001115 |
| Provider Name | Otniel Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003000720 PECOS PAC ID: 3870683139 Enrollment ID: I20190918000212 |
| Provider Name | Steven Grondalski |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1164509071 PECOS PAC ID: 2769712009 Enrollment ID: I20190930000527 |
| Provider Name | Vijay Kannan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1699188524 PECOS PAC ID: 1557638251 Enrollment ID: I20191007001520 |
| Provider Name | Content B Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124060090 PECOS PAC ID: 4587638762 Enrollment ID: I20191122000136 |
| Provider Name | Supriya Gupta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548521883 PECOS PAC ID: 5092004523 Enrollment ID: I20191203000373 |
| Provider Name | Yeu Shin Cindy Chang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003158817 PECOS PAC ID: 0648540880 Enrollment ID: I20200115001221 |
| Provider Name | Tina Evenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114151214 PECOS PAC ID: 3173669645 Enrollment ID: I20200310002228 |
| Provider Name | Vicken Y Totten |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831179001 PECOS PAC ID: 3375552995 Enrollment ID: I20200408001169 |
| Provider Name | Amy E Allegretti |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033193883 PECOS PAC ID: 2365478872 Enrollment ID: I20200707000779 |
| Provider Name | Pamela Sherwill-navarro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487181624 PECOS PAC ID: 8224462734 Enrollment ID: I20200902000045 |
| Provider Name | David N Ishimitsu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497919641 PECOS PAC ID: 3173783057 Enrollment ID: I20200924002219 |
| Provider Name | Jonathan I. Meyer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1265481725 PECOS PAC ID: 6709847833 Enrollment ID: I20200930000787 |
| Provider Name | Mahdieh Haji Amou Assar |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518953926 PECOS PAC ID: 5799675781 Enrollment ID: I20201013001345 |
| Provider Name | Patrick L Mccarthy |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1821098906 PECOS PAC ID: 3577469337 Enrollment ID: I20201102001090 |
| Provider Name | Catherine Anne Hallmark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790269496 PECOS PAC ID: 5092052217 Enrollment ID: I20201110001649 |
| Provider Name | Taylor M Miles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043665987 PECOS PAC ID: 5890032353 Enrollment ID: I20210210002254 |
| Provider Name | Michael Santarlas |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1548379613 PECOS PAC ID: 8921062449 Enrollment ID: I20210709000171 |
| Provider Name | Brett Jacob Schneiderman |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1831603125 PECOS PAC ID: 8325440670 Enrollment ID: I20210709001051 |
| Provider Name | Michael Dickerson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1073512059 PECOS PAC ID: 0143133371 Enrollment ID: I20210823000250 |
| Provider Name | Cynthia D Raya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770037251 PECOS PAC ID: 9335437144 Enrollment ID: I20220106002350 |
| Provider Name | Douglas Mckendry |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1285028092 PECOS PAC ID: 2264829209 Enrollment ID: I20220421002654 |
| Provider Name | Keith Arnold |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780117549 PECOS PAC ID: 1951679612 Enrollment ID: I20220708000847 |
| Provider Name | Brenda Kay Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275824120 PECOS PAC ID: 3678895232 Enrollment ID: I20220803001977 |
| Provider Name | Jesse Coenen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376832345 PECOS PAC ID: 4082839063 Enrollment ID: I20220805000476 |
| Provider Name | Todd Salmans |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1902858277 PECOS PAC ID: 3476879883 Enrollment ID: I20220915000285 |
| Provider Name | Michael Henry |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609338102 PECOS PAC ID: 5799168977 Enrollment ID: I20221003000241 |
| Provider Name | Jennifer E Panhorst |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285003186 PECOS PAC ID: 9032588124 Enrollment ID: I20221212002906 |
| Provider Name | Julie Ansell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336125103 PECOS PAC ID: 4587623871 Enrollment ID: I20230118002936 |
| Provider Name | Juan Herrera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275052490 PECOS PAC ID: 3678944782 Enrollment ID: I20230128000419 |
| Provider Name | John-michael T Watson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508202623 PECOS PAC ID: 9830330430 Enrollment ID: I20230317001249 |
| Provider Name | David P. Reiner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1174572572 PECOS PAC ID: 4981616661 Enrollment ID: I20230418001589 |
| Provider Name | David Lau |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1144303611 PECOS PAC ID: 3678938214 Enrollment ID: I20230503002207 |
| Provider Name | Lynester Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396344586 PECOS PAC ID: 3173929254 Enrollment ID: I20230505001452 |
| Provider Name | Joseph Lawton |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205368735 PECOS PAC ID: 4688908361 Enrollment ID: I20230614000083 |
| Provider Name | Betty Carpenter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336863778 PECOS PAC ID: 3779942396 Enrollment ID: I20230629002918 |
| Provider Name | Emily F Veltus |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1427687391 PECOS PAC ID: 4587026083 Enrollment ID: I20230815004275 |
| Provider Name | Quinn D Bott |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336572619 PECOS PAC ID: 0345664157 Enrollment ID: I20230821000087 |
| Provider Name | Cornelia Ann O'marra |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730278672 PECOS PAC ID: 0143684548 Enrollment ID: I20230919001924 |
| Provider Name | Camille Sue Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174821730 PECOS PAC ID: 8224266028 Enrollment ID: I20231002002635 |
| Provider Name | Charles Rocamboli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366639049 PECOS PAC ID: 1658398284 Enrollment ID: I20231003003463 |
Peach Springs Indian Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 943 Hualapai Way, Peach Springs, AZ 86434 Phone: 928-769-2900 |