| Copper Springs Hospital Physician Group Llc | |
|
10550 W Mcdowell Rd Avondale AZ 85392-4864 | |
| (480) 565-3035 | |
| Not Available |
| Full Name | Copper Springs Hospital Physician Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10550 W Mcdowell Rd, Avondale, Arizona |
| Authorized Official Name and Position | Greg Miller (EVO - CFO) |
| Authorized Official Contact | 4125883546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Copper Springs Hospital Physician Group Llc 101 S 5th St Louisville KY 40202-3157 Ph: () - | Copper Springs Hospital Physician Group Llc 10550 W Mcdowell Rd Avondale AZ 85392-4864 Ph: (480) 565-3035 |
| NPI Number | 1700238318 |
|---|---|
| Provider Enumeration Date | 07/07/2016 |
| Last Update Date | 05/20/2020 |
| Certification Date | 05/20/2020 |
| Medicare PECOS PAC ID | 1850675521 |
|---|---|
| Medicare Enrollment ID | O20170223001706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700238318 | NPI | - | NPPES |
| 237571 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| Provider Name | Andrea L Raby |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679645782 PECOS PAC ID: 4981591708 Enrollment ID: I20040304000335 |
| Provider Name | John J Lee |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1568534741 PECOS PAC ID: 9335153881 Enrollment ID: I20060203000413 |
| Provider Name | Jose Reyes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417923707 PECOS PAC ID: 5890898498 Enrollment ID: I20110215000250 |
| Provider Name | Joanna Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023482627 PECOS PAC ID: 3173826013 Enrollment ID: I20160928001244 |
| Provider Name | Pedram Amani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174814594 PECOS PAC ID: 6002199072 Enrollment ID: I20170217000551 |
| Provider Name | Scott Kirkorsky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285079632 PECOS PAC ID: 7113295247 Enrollment ID: I20171010003653 |
| Provider Name | Meera Mehta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952788143 PECOS PAC ID: 6204140593 Enrollment ID: I20190329000971 |
| Provider Name | Marjo Ann Doyle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699156695 PECOS PAC ID: 9739492265 Enrollment ID: I20190416002606 |
| Provider Name | Kenneth Richmond |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184891277 PECOS PAC ID: 6608015342 Enrollment ID: I20190809002954 |
| Provider Name | Jacqueline Jones Toal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215488697 PECOS PAC ID: 8628358843 Enrollment ID: I20190816000700 |
| Provider Name | Khalid Salim Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821452418 PECOS PAC ID: 1153696653 Enrollment ID: I20190820001834 |
| Provider Name | Aaron S Kramer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558715490 PECOS PAC ID: 8123454717 Enrollment ID: I20200129002664 |
| Provider Name | Daniel Villa-quevedo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235714189 PECOS PAC ID: 5092119503 Enrollment ID: I20210805001847 |
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