| Asura Healthcare Llc | |
|
12075 E State Route 69 Ste B Dewey AZ 86327-4517 | |
| (405) 590-8861 | |
| (888) 389-7077 |
| Full Name | Asura Healthcare Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 12075 E State Route 69 Ste B, Dewey, Arizona |
| Authorized Official Name and Position | John S Gilliam (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4055908861 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Asura Healthcare Llc 303 E Gurley St Unit 479 Prescott AZ 86301-3804 Ph: (405) 590-8861 | Asura Healthcare Llc 12075 E State Route 69 Ste B Dewey AZ 86327-4517 Ph: (405) 590-8861 |
| NPI Number | 1669991485 |
|---|---|
| Provider Enumeration Date | 09/13/2017 |
| Last Update Date | 09/13/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669991485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | AP3224 (Arizona) | Secondary |
| 207Q00000X | Family Medicine | 41469 (Arizona) | Primary |
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