| Advanced Health And Wellness Az | |
|
4830 Highway 260 Ste 102 Lakeside AZ 85929 | |
| (928) 537-7111 | |
| (928) 532-1129 |
| Full Name | Advanced Health And Wellness Az |
|---|---|
| Speciality | Clinic/Center |
| Location | 4830 Highway 260 Ste 102, Lakeside, Arizona |
| Authorized Official Name and Position | Hugh Ryan Hall (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9285377111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Health And Wellness Az 4830 Highway 260 Ste 102 Lakeside AZ 85929-5851 Ph: (928) 537-7111 | Advanced Health And Wellness Az 4830 Highway 260 Ste 102 Lakeside AZ 85929 Ph: (928) 537-7111 |
| NPI Number | 1154827863 |
|---|---|
| Provider Enumeration Date | 04/02/2018 |
| Last Update Date | 06/07/2018 |
| Medicare PECOS PAC ID | 8628332467 |
|---|---|
| Medicare Enrollment ID | O20180503001000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154827863 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Arizona) | Primary |
| Provider Name | Hugh R Hall |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1952352619 PECOS PAC ID: 9638172752 Enrollment ID: I20060810000289 |
| Provider Name | Richard S Lunt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396050944 PECOS PAC ID: 2062691488 Enrollment ID: I20110131000892 |
| Provider Name | Matthew Marshall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073925319 PECOS PAC ID: 8527284884 Enrollment ID: I20140722000934 |
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