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Us 191 & Az 264 Ganado AZ 86505-0457 | |
(928) 755-4500 | |
(928) 755-4932 |
Full Name | |
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Speciality | Clinic/Center |
Location | Us 191 & Az 264, Ganado, Arizona |
Authorized Official Name and Position | Andrea Curley (MEDICAL STAFF CREDENTIALIST) |
Authorized Official Contact | 9287554500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 457 Ganado AZ 86505-0457 Ph: (928) 755-4500 | Us 191 & Az 264 Ganado AZ 86505-0457 Ph: (928) 755-4500 |
NPI Number | 1750508651 |
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Provider Enumeration Date | 04/20/2007 |
Last Update Date | 11/14/2024 |
Medicare PECOS PAC ID | 2163332347 |
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Medicare Enrollment ID | O20090729000481 |
Identifier | Type | State | Issuer |
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1750508651 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | RGH3899 (Arizona) | Primary |