Versatile Medicine Pllc | |
13055 W Mcdowell Rd Suite E-106 Avondale AZ 85392-6449 | |
(623) 975-8400 | |
(623) 935-2975 |
Full Name | Versatile Medicine Pllc |
---|---|
Speciality | Internal Medicine |
Location | 13055 W Mcdowell Rd, Avondale, Arizona |
Authorized Official Name and Position | Kathleen A Nichols (PHYSICIAN/GENERAL MANAGER) |
Authorized Official Contact | 6239758400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Versatile Medicine Pllc 13055 W Mcdowell Rd Suite E-106 Avondale AZ 85392-6449 Ph: (623) 975-8400 | Versatile Medicine Pllc 13055 W Mcdowell Rd Suite E-106 Avondale AZ 85392-6449 Ph: (623) 975-8400 |
NPI Number | 1326145608 |
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Provider Enumeration Date | 09/20/2006 |
Last Update Date | 06/08/2015 |
Medicare PECOS PAC ID | 3274597133 |
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Medicare Enrollment ID | O20041119000233 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326145608 | NPI | - | NPPES |
AZ0761300 | Other | AZ | BLUE CROSS BLUE SHIELD |
AZ0765500 | Other | AZ | BLUE CROSS BLUE SHIELD |
517675 | Medicaid | AZ | |
486581001 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | AZ26993 (Arizona) | Primary |
Provider Name | Kathleen A Nichols |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1245241215 PECOS PAC ID: 5698743078 Enrollment ID: I20040923000179 |
Provider Name | Terry Hicks Woodbeck |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1891706875 PECOS PAC ID: 5991734188 Enrollment ID: I20050808001090 |
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