| Pebble Creek Medical Group Pllc | |
|
700 N Estrella Pkwy # 130 Goodyear AZ 85338-9271 | |
| (623) 322-2144 | |
| (623) 322-1165 |
| Full Name | Pebble Creek Medical Group Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 700 N Estrella Pkwy # 130, Goodyear, Arizona |
| Authorized Official Name and Position | Sanjay Bommakanti (MD/OWNER) |
| Authorized Official Contact | 6233376897 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pebble Creek Medical Group Pllc 18210 N Organ Pipe Dr Sun City AZ 85373-1757 Ph: (602) 410-6951 | Pebble Creek Medical Group Pllc 700 N Estrella Pkwy # 130 Goodyear AZ 85338-9271 Ph: (623) 322-2144 |
| NPI Number | 1790213064 |
|---|---|
| Provider Enumeration Date | 05/31/2017 |
| Last Update Date | 05/31/2017 |
| Medicare PECOS PAC ID | 5890066724 |
|---|---|
| Medicare Enrollment ID | O20170810001224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790213064 | NPI | - | NPPES |
| 281108 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 37252 (Arizona) | Primary |
| Provider Name | Fnu Pranav |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952327116 PECOS PAC ID: 5890795165 Enrollment ID: I20070110000510 |
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