| Jeremy Ganz, PA | |
|
27th Special Operations Medical Group, 224 W D. L. Ingram Avenue, Bldg. 1408, Clovis, NM 88103 | |
| (314) 226-8463 | |
| Not Available |
| Full Name | Jeremy Ganz |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 27th Special Operations Medical Group, Clovis, New Mexico |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053805671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | (* (Not Available)) | Primary |
| 171000000X | Military Health Care Provider | (* (Not Available)) | Secondary |
| Entity Name | Fedko Emergency Physicians New Mexico, LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770047441 PECOS PAC ID: 4880934389 Enrollment ID: O20190320001146 |
| Mailing Address | Practice Location Address |
|---|---|
| Jeremy Ganz, PA 27th Special Operations Medical Group, 224 W D. L. Ingram Avenue, Bldg. 1408, Cannon Afb, NM 88103 Ph: Not Available | Jeremy Ganz, PA 27th Special Operations Medical Group, 224 W D. L. Ingram Avenue, Bldg. 1408, Clovis, NM 88103 Ph: (314) 226-8463 |
Mark A Standley, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2200 W 21st St, Same Day Care Clinic - Clovis, Clovis, NM 88101 Phone: 505-769-7577 Fax: 505-769-6374 |
Charla Marie Dunn, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2100 N Mlk Blvd, Clovis, NM 88101 Phone: 575-769-7494 Fax: 575-769-7324 |
Mr. Charles Daniel Otero, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 701 Arizona St, Suite A, Clovis, NM 88101 Phone: 575-742-3033 Fax: 575-742-1133 |
Diana Manis Fick, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2421 W 21st St Ste B, General Surgery - Clovis, Clovis, NM 88101 Phone: 575-769-7577 Fax: 575-742-7856 |
Yannick Sharras, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 113 Albright Ave E, Clovis, NM 88103 Phone: 470-830-3811 |
Robert Dale Bitner, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 208 W Casablanca Ave, Bldg 1400 Cannon Afb 27 Medical Group, Clovis, NM 88103 Phone: 505-784-6608 Fax: 505-784-6028 |