| Providence Service, Llc | |
|
2530 W Allens Peak Dr Queen Creek AZ 85142-4642 | |
| (615) 668-4485 | |
| (480) 812-3131 |
| Full Name | Providence Service, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2530 W Allens Peak Dr, Queen Creek, Arizona |
| Authorized Official Name and Position | Olayinka O Osinloye (FNP/PMHNP) |
| Authorized Official Contact | 6156684485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Service, Llc 2530 W Allens Peak Dr Queen Creek AZ 85142-4642 Ph: (615) 668-4485 | Providence Service, Llc 2530 W Allens Peak Dr Queen Creek AZ 85142-4642 Ph: (615) 668-4485 |
| NPI Number | 1245593268 |
|---|---|
| Provider Enumeration Date | 06/25/2012 |
| Last Update Date | 11/22/2022 |
| Medicare PECOS PAC ID | 1557732617 |
|---|---|
| Medicare Enrollment ID | O20230127001095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245593268 | NPI | - | NPPES |
| 1524996 | Medicaid | TN | |
| Z181765 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | APN0000015886 (Tennessee) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Olayinka O Osinloye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518246214 PECOS PAC ID: 0042479487 Enrollment ID: I20151028001461 |
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