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3124 Willow Creek Rd Prescott AZ 86301-6610 | |
(923) 445-7085 | |
(923) 445-7085 |
Full Name | |
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Speciality | Family Medicine |
Location | 3124 Willow Creek Rd, Prescott, Arizona |
Authorized Official Name and Position | Meryam Ahmad (VP OF REVENUE CYCLE) |
Authorized Official Contact | 9366766415 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3514 Cedar Springs Rd Dallas TX 75219-4901 Ph: (469) 341-7800 | 3124 Willow Creek Rd Prescott AZ 86301-6610 Ph: (923) 445-7085 |
NPI Number | 1184408874 |
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Provider Enumeration Date | 08/23/2023 |
Last Update Date | 09/19/2023 |
Medicare PECOS PAC ID | 5092151696 |
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Medicare Enrollment ID | O20240305004562 |
Identifier | Type | State | Issuer |
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1184408874 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Kelly L Tracey |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1255441143 PECOS PAC ID: 2961486113 Enrollment ID: I20040712001214 |
Provider Name | Samuel Sanchez |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1780693861 PECOS PAC ID: 2264338714 Enrollment ID: I20130724000094 |
Provider Name | Christopher Novack |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366825978 PECOS PAC ID: 2567762743 Enrollment ID: I20171205001671 |
Provider Name | Kenna Jan Stephenson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1962697755 PECOS PAC ID: 2860570033 Enrollment ID: I20211013001513 |
Provider Name | Sandra L Adams |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578124541 PECOS PAC ID: 2769869668 Enrollment ID: I20220516000537 |
Provider Name | Sean A Maiolo |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1487147682 PECOS PAC ID: 1153674825 Enrollment ID: I20220708003147 |
Provider Name | Julia Davis |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1396206603 PECOS PAC ID: 7517291669 Enrollment ID: I20231218002874 |
Ellen F Bunch Md Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1456 W Gurley St, Prescott, AZ 86305 Phone: 928-777-8880 Fax: 928-777-8884 | |
Fred S Markham Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 804 Ainsworth Dr, Suite 104, Prescott, AZ 86301 Phone: 928-778-1736 Fax: 928-717-0785 | |
Yavapai Regional Medical Center Physician Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 726 Gail Gardner Way, Suite B, Prescott, AZ 86305 Phone: 928-445-0304 | |