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1134 W Us Highway 60 Superior AZ 85173 | |
(520) 689-2423 | |
(520) 689-5237 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1134 W Us Highway 60, Superior, Arizona |
Authorized Official Name and Position | Neal D. Jensen (CEO) |
Authorized Official Contact | 9284253261 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1134 W Us Highway 60 Superior AZ 85173-3400 Ph: (520) 689-2423 | 1134 W Us Highway 60 Superior AZ 85173 Ph: (520) 689-2423 |
NPI Number | 1649245135 |
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Provider Enumeration Date | 02/20/2006 |
Last Update Date | 08/09/2018 |
Medicare PECOS PAC ID | 0648181693 |
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Medicare Enrollment ID | O20040902001147 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649245135 | NPI | - | NPPES |
934467 | Medicaid | AZ | |
1649245135 | Other | AZ | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | H0126 (Arizona) | Primary |