| Bonhoeffer Rheumatology Institute, Llc | |
|
2451 E Baseline Rd Suite 425 Gilbert AZ 85234-2471 | |
| (480) 494-2770 | |
| (480) 494-2771 |
| Full Name | Bonhoeffer Rheumatology Institute, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2451 E Baseline Rd, Gilbert, Arizona |
| Authorized Official Name and Position | W Richard Horn (MANAGER) |
| Authorized Official Contact | 4804942770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonhoeffer Rheumatology Institute, Llc 2451 E Baseline Rd Suite 425 Gilbert AZ 85234-2471 Ph: (480) 494-2770 | Bonhoeffer Rheumatology Institute, Llc 2451 E Baseline Rd Suite 425 Gilbert AZ 85234-2471 Ph: (480) 494-2770 |
| NPI Number | 1811372345 |
|---|---|
| Provider Enumeration Date | 07/27/2015 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 1850601360 |
|---|---|
| Medicare Enrollment ID | O20151113000518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811372345 | NPI | - | NPPES |
| 2015015625 | Other | AZ | ANCC |
| 041844 | Medicaid | AZ | |
| 12739741 | Other | AZ | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 12739741 (Arizona) | Primary |
| Provider Name | W R Horn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205912987 PECOS PAC ID: 2860554177 Enrollment ID: I20081222000642 |
| Provider Name | Brittany S Panico |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1811253677 PECOS PAC ID: 0143521898 Enrollment ID: I20200807001016 |
| Provider Name | Peter Paul Moheb Hennis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588233175 PECOS PAC ID: 9638572035 Enrollment ID: I20210728002566 |
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