| Premier Mountain Healthcare Llc | |
|
5300 S Sutter Dr Ste A Show Low AZ 85901-8054 | |
| (928) 634-5118 | |
| Not Available |
| Full Name | Premier Mountain Healthcare Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5300 S Sutter Dr Ste A, Show Low, Arizona |
| Authorized Official Name and Position | Stella Crozier (CREDENTIALING) |
| Authorized Official Contact | 9286345118 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Mountain Healthcare Llc 5300 S Sutter Dr Ste A Show Low AZ 85901-8054 Ph: () - | Premier Mountain Healthcare Llc 5300 S Sutter Dr Ste A Show Low AZ 85901-8054 Ph: (928) 634-5118 |
| NPI Number | 1881261857 |
|---|---|
| Provider Enumeration Date | 06/08/2021 |
| Last Update Date | 10/20/2021 |
| Medicare PECOS PAC ID | 4486058930 |
|---|---|
| Medicare Enrollment ID | O20210805003605 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881261857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| Provider Name | Leon A Driss |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669445706 PECOS PAC ID: 4385531516 Enrollment ID: I20051103000015 |
| Provider Name | Elizabeth W Bierer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821329129 PECOS PAC ID: 9436329711 Enrollment ID: I20110823000995 |
| Provider Name | Bryan Sean Smithson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336377464 PECOS PAC ID: 4385838200 Enrollment ID: I20120724000101 |
| Provider Name | Michele Mccormick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588199160 PECOS PAC ID: 3072882158 Enrollment ID: I20170705001856 |
| Provider Name | Mary Jane Wild Sorenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851870919 PECOS PAC ID: 8325392061 Enrollment ID: I20181114003617 |
| Provider Name | Kimberly Ann Hansen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952074072 PECOS PAC ID: 9638577729 Enrollment ID: I20211004001519 |
| Provider Name | Lyndsay Leigh Rebecca Funk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124784657 PECOS PAC ID: 1951792175 Enrollment ID: I20211223001283 |
| Provider Name | Jay Calvin Kempton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972187466 PECOS PAC ID: 0244613164 Enrollment ID: I20220810001132 |
| Provider Name | Kimberly R Novak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184346793 PECOS PAC ID: 6305215435 Enrollment ID: I20221213001682 |
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