| Optum Primary Care | |
|
13613 W Camino Del Sol St 5 Sun City West AZ 85375-4480 | |
| (623) 584-7154 | |
| Not Available |
| Full Name | Optum Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 13613 W Camino Del Sol, Sun City West, Arizona |
| Authorized Official Name and Position | Emily Castillo (REGIONAL MANAGER) |
| Authorized Official Contact | 7024802550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optum Primary Care 13613 W Camino Del Sol St 5 Sun City West AZ 85375-4480 Ph: (623) 584-7154 | Optum Primary Care 13613 W Camino Del Sol St 5 Sun City West AZ 85375-4480 Ph: (623) 584-7154 |
| NPI Number | 1235187923 |
|---|---|
| Provider Enumeration Date | 05/04/2006 |
| Last Update Date | 09/02/2023 |
| Medicare PECOS PAC ID | 6406009562 |
|---|---|
| Medicare Enrollment ID | O20130123000556 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235187923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 21719 (Arizona) | Primary |
| Provider Name | Constantin Siclovan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164613675 PECOS PAC ID: 1052302056 Enrollment ID: I20040519000901 |
| Provider Name | Kelly L Tracey |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255441143 PECOS PAC ID: 2961486113 Enrollment ID: I20040712001214 |
| Provider Name | Shanyn C Lancaster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790858462 PECOS PAC ID: 1557363827 Enrollment ID: I20220329001920 |
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