| True Diabetes Neuropathy & Wound Solutions Az Llc | |
|
5171 S Cub Lake Rd Ste C330 Show Low AZ 85901-7997 | |
| (928) 243-0348 | |
| (928) 328-1288 |
| Full Name | True Diabetes Neuropathy & Wound Solutions Az Llc |
|---|---|
| Speciality | General Practice |
| Location | 5171 S Cub Lake Rd Ste C330, Show Low, Arizona |
| Authorized Official Name and Position | Patrick Smith (CHIEF INFORMATION OFFICER) |
| Authorized Official Contact | 4807401910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| True Diabetes Neuropathy & Wound Solutions Az Llc 5171 S Cub Lake Rd Ste C330 Show Low AZ 85901-7997 Ph: (928) 243-0348 | True Diabetes Neuropathy & Wound Solutions Az Llc 5171 S Cub Lake Rd Ste C330 Show Low AZ 85901-7997 Ph: (928) 243-0348 |
| NPI Number | 1912699240 |
|---|---|
| Provider Enumeration Date | 05/24/2023 |
| Last Update Date | 02/12/2024 |
| Medicare PECOS PAC ID | 3779942008 |
|---|---|
| Medicare Enrollment ID | O20230705002976 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912699240 | NPI | - | NPPES |
| 1366183212 | Other | AZ | NPI |
| 1598314247 | Other | AZ | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Lu Ann Penchuk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548577695 PECOS PAC ID: 0749452803 Enrollment ID: I20111013000477 |
| Provider Name | Tawnya M Grover |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598314247 PECOS PAC ID: 3072945021 Enrollment ID: I20191113002976 |
| Provider Name | Debora Finch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366183212 PECOS PAC ID: 5597121715 Enrollment ID: I20231115001246 |
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