| Mountain Dew Behavioral Health Plc | |
|
6700 N Oracle Rd Suite 119 Tucson AZ 85704-7732 | |
| (520) 389-8468 | |
| Not Available |
| Full Name | Mountain Dew Behavioral Health Plc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6700 N Oracle Rd, Tucson, Arizona |
| Authorized Official Name and Position | James Abanishe (CHAIRMAN/MEDICAL DIRECTOR) |
| Authorized Official Contact | 9173767720 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Dew Behavioral Health Plc 6700 N Oracle Rd Tucson AZ 85704-7732 Ph: () - | Mountain Dew Behavioral Health Plc 6700 N Oracle Rd Suite 119 Tucson AZ 85704-7732 Ph: (520) 389-8468 |
| NPI Number | 1790130482 |
|---|---|
| Provider Enumeration Date | 04/30/2016 |
| Last Update Date | 03/08/2017 |
| Medicare PECOS PAC ID | 9931484136 |
|---|---|
| Medicare Enrollment ID | O20170331000207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790130482 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 50979 (Arizona) | Primary |
| Provider Name | James O Abanishe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992053573 PECOS PAC ID: 1052627387 Enrollment ID: I20150902000156 |
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