| San Pedro Health Pllc | |
|
4151 La Linda Way Suite # 102 Sierra Vista AZ 85635-4600 | |
| (520) 515-9610 | |
| (520) 515-0031 |
| Full Name | San Pedro Health Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4151 La Linda Way, Sierra Vista, Arizona |
| Authorized Official Name and Position | James Phillip Reed (MANAGER) |
| Authorized Official Contact | 5205159610 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Pedro Health Pllc 4151 La Linda Way Suite # 102 Sierra Vista AZ 85635-4600 Ph: (520) 515-9610 | San Pedro Health Pllc 4151 La Linda Way Suite # 102 Sierra Vista AZ 85635-4600 Ph: (520) 515-9610 |
| NPI Number | 1245501188 |
|---|---|
| Provider Enumeration Date | 01/24/2012 |
| Last Update Date | 04/30/2021 |
| Certification Date | 04/30/2021 |
| Medicare PECOS PAC ID | 5496917783 |
|---|---|
| Medicare Enrollment ID | O20120502000659 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245501188 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2845 (Arizona) | Primary |
| Provider Name | James P Reed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790719441 PECOS PAC ID: 0648297283 Enrollment ID: I20051102000084 |
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