Unchained-gilbert Llc | |
201 W Guadalupe Rd Ste 310 Gilbert AZ 85233-3319 | |
(480) 619-2868 | |
Not Available |
Full Name | Unchained-gilbert Llc |
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Speciality | Psychiatry & Neurology |
Location | 201 W Guadalupe Rd Ste 310, Gilbert, Arizona |
Authorized Official Name and Position | Mason Lundell (MANAGER) |
Authorized Official Contact | 4806192868 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Unchained-gilbert Llc 2312 E Orleans Dr Gilbert AZ 85298-0323 Ph: (480) 619-2868 | Unchained-gilbert Llc 201 W Guadalupe Rd Ste 310 Gilbert AZ 85233-3319 Ph: (480) 619-2868 |
NPI Number | 1578274346 |
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Provider Enumeration Date | 12/12/2022 |
Last Update Date | 12/12/2022 |
Certification Date | 12/12/2022 |
Medicare PECOS PAC ID | 8527424100 |
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Medicare Enrollment ID | O20230524002283 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578274346 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
Provider Name | John J Lee |
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Provider Type | Practitioner - Osteopathic Manipulative Medicine |
Provider Identifiers | NPI Number: 1568534741 PECOS PAC ID: 9335153881 Enrollment ID: I20060203000413 |
Provider Name | Jerica Elaine M Lim |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043884026 PECOS PAC ID: 7618379447 Enrollment ID: I20210715001933 |
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