| Mr Michael Keene Demack, PA C S | |
|
806 S Ponderosa St, Payson, AZ 85541-5541 | |
| (928) 468-8603 | |
| (928) 468-8625 |
| Full Name | Mr Michael Keene Demack |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant - Medical |
| Location | 806 S Ponderosa St, Payson, Arizona |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043347313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 6422 (Arizona) | Primary |
| 207Q00000X | Family Medicine | PA 14934 (California) | Secondary |
| Entity Name | Ponderosa Family Care LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1144535626 PECOS PAC ID: 1456548015 Enrollment ID: O20101208000388 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Michael Keene Demack, PA C S Po Box 2901, Payson, AZ 85547-2901 Ph: (928) 468-8603 | Mr Michael Keene Demack, PA C S 806 S Ponderosa St, Payson, AZ 85541-5541 Ph: (928) 468-8603 |
Lilly Ann Mabel Thurlow, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 807 S Ponderosa St, Payson, AZ 85541 Phone: 928-471-3222 |
Diane M Scott, P.A. Physician Assistant Medicare: Medicare Enrolled Practice Location: 126 E Main St, Suite D, Payson, AZ 85541 Phone: 928-472-5260 Fax: 928-472-3444 |
Mr. Richard D Hobson, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 807 S Ponderosa St, Payson, AZ 85541 Phone: 602-386-9982 Fax: 484-231-9982 |
Paul Schoeneberger, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 708 S Coeur D Alene Ln Ste B, Payson, AZ 85541 Phone: 928-468-8603 Fax: 928-468-8625 |
Andrew Quast, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 101 E State Highway 260 Ste G, Payson, AZ 85541 Phone: 928-596-4570 |
Jessica Rae Parker, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 117 E Main St, Suite A 100, Payson, AZ 85541 Phone: 928-474-1714 Fax: 928-468-7644 |
Gerald Bossert, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 126 E Main St, Suite D, Payson, AZ 85541 Phone: 928-472-5260 |