Restore Dme Medical Group, Llc | |
6410 S Kings Ranch Rd Ste 1 Gold Canyon AZ 85118-7352 | |
(480) 689-9205 | |
(480) 288-2879 |
Full Name | Restore Dme Medical Group, Llc |
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Speciality | Family Medicine |
Location | 6410 S Kings Ranch Rd, Gold Canyon, Arizona |
Authorized Official Name and Position | Robert Christiaan Allen (OWNER) |
Authorized Official Contact | 4806899205 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Restore Dme Medical Group, Llc 6410 S Kings Ranch Rd Ste 1 Gold Canyon AZ 85118-7352 Ph: (480) 689-9205 | Restore Dme Medical Group, Llc 6410 S Kings Ranch Rd Ste 1 Gold Canyon AZ 85118-7352 Ph: (480) 689-9205 |
NPI Number | 1104287697 |
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Provider Enumeration Date | 03/11/2016 |
Last Update Date | 03/11/2016 |
Medicare PECOS PAC ID | 5991081739 |
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Medicare Enrollment ID | O20170519001498 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104287697 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 30153 (Arizona) | Primary |
Provider Name | Robert C Allen |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1639195977 PECOS PAC ID: 0749386852 Enrollment ID: I20080116000055 |
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