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124 N Tewskbury Blvd Young AZ 85554-0000 | |
(928) 462-3435 | |
(928) 462-6644 |
Full Name | |
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Speciality | Clinic/Center |
Location | 124 N Tewskbury Blvd, Young, Arizona |
Authorized Official Name and Position | Neal D Jensen (CEO) |
Authorized Official Contact | 9284253261 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 177 Young AZ 85554-0000 Ph: (928) 462-3435 | 124 N Tewskbury Blvd Young AZ 85554-0000 Ph: (928) 462-3435 |
NPI Number | 1497021844 |
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Provider Enumeration Date | 03/30/2012 |
Last Update Date | 01/30/2013 |
Medicare PECOS PAC ID | 0648181693 |
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Medicare Enrollment ID | O20030925000001 |
Identifier | Type | State | Issuer |
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1497021844 | NPI | - | NPPES |
371306 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | H0126 (Arizona) | Primary |