| Southwellness Medical Llc | |
|
10599 N Tatum Blvd Ste F151 Paradise Valley AZ 85253-1053 | |
| (480) 991-9271 | |
| (844) 284-7758 |
| Full Name | Southwellness Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 10599 N Tatum Blvd Ste F151, Paradise Valley, Arizona |
| Authorized Official Name and Position | Tyler John Southwell (CEO) |
| Authorized Official Contact | 4809919271 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwellness Medical Llc 10599 N Tatum Blvd Ste F151 Paradise Valley AZ 85253-1053 Ph: (480) 991-9271 | Southwellness Medical Llc 10599 N Tatum Blvd Ste F151 Paradise Valley AZ 85253-1053 Ph: (480) 991-9271 |
| NPI Number | 1366099533 |
|---|---|
| Provider Enumeration Date | 08/22/2019 |
| Last Update Date | 10/15/2020 |
| Medicare PECOS PAC ID | 8628486628 |
|---|---|
| Medicare Enrollment ID | O20210412001458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366099533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Tyler J Southwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194980367 PECOS PAC ID: 9931356466 Enrollment ID: I20130614000425 |
| Provider Name | Brittany M Divito |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023546249 PECOS PAC ID: 5193096345 Enrollment ID: I20170807000243 |
| Provider Name | Emily Broghan Schutsky Snyder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699342642 PECOS PAC ID: 5799186029 Enrollment ID: I20210624001479 |
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