| Balance Nutrition With Andi Llc | |
|
41810 N Venture Dr Unit C122 Anthem AZ 85086-3172 | |
| (623) 688-1498 | |
| Not Available |
| Full Name | Balance Nutrition With Andi Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 41810 N Venture Dr Unit C122, Anthem, Arizona |
| Authorized Official Name and Position | Andi Coffee (CEO) |
| Authorized Official Contact | 6236881498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Balance Nutrition With Andi Llc 41810 N Venture Dr Unit C122 Anthem AZ 85086-3172 Ph: () - | Balance Nutrition With Andi Llc 41810 N Venture Dr Unit C122 Anthem AZ 85086-3172 Ph: (623) 688-1498 |
| NPI Number | 1306621032 |
|---|---|
| Provider Enumeration Date | 08/30/2023 |
| Last Update Date | 08/30/2023 |
| Medicare PECOS PAC ID | 6709232333 |
|---|---|
| Medicare Enrollment ID | O20231102000339 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306621032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Andi M Coffee |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1609487008 PECOS PAC ID: 0042664252 Enrollment ID: I20231102000377 |
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