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39726 Harquahala Road Salome AZ 85348 | |
(928) 859-3460 | |
(928) 859-3475 |
Full Name | |
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Speciality | Clinic/Center |
Location | 39726 Harquahala Road, Salome, Arizona |
Authorized Official Name and Position | Kevin Brown (CEO) |
Authorized Official Contact | 9286697300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1200 W Mohave Rd Parker AZ 85344-6349 Ph: (928) 669-9201 | 39726 Harquahala Road Salome AZ 85348 Ph: (928) 859-3460 |
NPI Number | 1629093539 |
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Provider Enumeration Date | 07/12/2006 |
Last Update Date | 06/06/2017 |
Medicare PECOS PAC ID | 1557273356 |
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Medicare Enrollment ID | O20050628001431 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629093539 | NPI | - | NPPES |
480046 | Medicaid | AZ | |
CG7880 | Other | AZ | MEDICARE RR |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | H0138 (Arizona) | Primary |