| The Amistad Clinic, Pllc | |
|
100 E 24th St Ste 3a Yuma AZ 85364-8619 | |
| (773) 230-9645 | |
| Not Available |
| Full Name | The Amistad Clinic, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 100 E 24th St Ste 3a, Yuma, Arizona |
| Authorized Official Name and Position | William Bautista Amistad (PROVIDER) |
| Authorized Official Contact | 4807738569 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Amistad Clinic, Pllc 100 E 24th St Ste 3a Yuma AZ 85364-8619 Ph: (928) 750-6410 | The Amistad Clinic, Pllc 100 E 24th St Ste 3a Yuma AZ 85364-8619 Ph: (773) 230-9645 |
| NPI Number | 1639650898 |
|---|---|
| Provider Enumeration Date | 08/27/2018 |
| Last Update Date | 09/21/2023 |
| Medicare PECOS PAC ID | 1557613536 |
|---|---|
| Medicare Enrollment ID | O20181003001655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639650898 | NPI | - | NPPES |
| 205215 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | AP9557 (Arizona) | Primary |
| 261QP2300X | Clinic/center - Primary Care | AP9557 (Arizona) | Secondary |
| Provider Name | William Amistad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215380969 PECOS PAC ID: 2961782339 Enrollment ID: I20161201001553 |
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