| San Tan Primary Care Pc | |
|
36283 N Gantzel Rd Ste 101 San Tan Valley AZ 85140-7322 | |
| (480) 351-7277 | |
| (480) 219-5457 |
| Full Name | San Tan Primary Care Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 36283 N Gantzel Rd Ste 101, San Tan Valley, Arizona |
| Authorized Official Name and Position | Brian C Andrews (OWNER) |
| Authorized Official Contact | 4803517277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Tan Primary Care Pc 36283 N Gantzel Rd Ste 101 San Tan Valley AZ 85140-7322 Ph: (480) 505-3294 | San Tan Primary Care Pc 36283 N Gantzel Rd Ste 101 San Tan Valley AZ 85140-7322 Ph: (480) 351-7277 |
| NPI Number | 1497249452 |
|---|---|
| Provider Enumeration Date | 06/21/2018 |
| Last Update Date | 12/28/2020 |
| Medicare PECOS PAC ID | 2567703291 |
|---|---|
| Medicare Enrollment ID | O20190408000696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497249452 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Brian C Andrews |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326127473 PECOS PAC ID: 2567449374 Enrollment ID: I20040630000466 |
| Provider Name | Tanya Balov |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164801205 PECOS PAC ID: 6507169802 Enrollment ID: I20180807001309 |
| Provider Name | Carley A Vento |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689289258 PECOS PAC ID: 5294153482 Enrollment ID: I20200921002105 |
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