| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 03/11/2016 |
| Last Update Date | 03/11/2016 |
| Medicare PECOS PAC ID | 5991081739 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639195977 PECOS PAC ID: 0749386852 Enrollment ID: I20080116000055 |
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