| Cleanslate Medical Group Of Arizona Pllc | |
|
15255 N 40th St Ste 135 Phoenix AZ 85032-4682 | |
| (480) 417-4215 | |
| (833) 279-7074 |
| Full Name | Cleanslate Medical Group Of Arizona Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 15255 N 40th St Ste 135, Phoenix, Arizona |
| Authorized Official Name and Position | Matthew Philip Smolarek (CFO) |
| Authorized Official Contact | 4129995188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cleanslate Medical Group Of Arizona Pllc 8 Cadillac Dr Ste 180 Brentwood TN 37027-5393 Ph: (615) 425-0220 | Cleanslate Medical Group Of Arizona Pllc 15255 N 40th St Ste 135 Phoenix AZ 85032-4682 Ph: (480) 417-4215 |
| NPI Number | 1801421656 |
|---|---|
| Provider Enumeration Date | 03/11/2020 |
| Last Update Date | 05/08/2025 |
| Certification Date | 05/08/2025 |
| Medicare PECOS PAC ID | 6901183235 |
|---|---|
| Medicare Enrollment ID | O20170515001155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801421656 | NPI | - | NPPES |
| Provider Name | Susan A Orsich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467766899 PECOS PAC ID: 2668664756 Enrollment ID: I20101007000695 |
| Provider Name | Rick Michael Wesley Sloan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124128954 PECOS PAC ID: 2365471869 Enrollment ID: I20101227000511 |
| Provider Name | Adam Heath |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841550811 PECOS PAC ID: 4284951013 Enrollment ID: I20170712000472 |
| Provider Name | Velma Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154812097 PECOS PAC ID: 5496091852 Enrollment ID: I20190107002507 |
| Provider Name | Jennifer Natasha Kunz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578025136 PECOS PAC ID: 5496089633 Enrollment ID: I20190621002796 |
| Provider Name | Sally Combest |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1790892776 PECOS PAC ID: 0143282673 Enrollment ID: I20191025002614 |
| Provider Name | Leen N Naji |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952033698 PECOS PAC ID: 6103201686 Enrollment ID: I20230720002122 |
| Provider Name | Angela M Boyd |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740746643 PECOS PAC ID: 9234582560 Enrollment ID: I20240201004647 |
| Provider Name | Kendra Anderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497496723 PECOS PAC ID: 8022456912 Enrollment ID: I20240411001023 |
| Provider Name | Adeyemi Fatoki |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1760449938 PECOS PAC ID: 3971497421 Enrollment ID: I20250401002727 |
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