| Business Office | |
|
1205 F. Avenue Douglas AZ 85607 | |
| (520) 364-1429 | |
| (520) 364-4261 |
| Full Name | Business Office |
|---|---|
| Speciality | Clinic/Center |
| Location | 1205 F. Avenue, Douglas, Arizona |
| Authorized Official Name and Position | Jonathan Melk (CEO) |
| Authorized Official Contact | 5203641429 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Business Office 1205 F Ave Douglas AZ 85607-1920 Ph: (520) 364-1429 | Business Office 1205 F. Avenue Douglas AZ 85607 Ph: (520) 364-1429 |
| NPI Number | 1942241443 |
|---|---|
| Provider Enumeration Date | 06/08/2006 |
| Last Update Date | 02/08/2017 |
| Medicare PECOS PAC ID | 5395638878 |
|---|---|
| Medicare Enrollment ID | O20040206000860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942241443 | NPI | - | NPPES |
| 433053 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
| Provider Name | Kathleen J Vedock |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1235103508 PECOS PAC ID: 4082506001 Enrollment ID: I20040325001276 |
| Provider Name | Clinton L Huston |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1235171844 PECOS PAC ID: 9234170333 Enrollment ID: I20050519000095 |
| Provider Name | Darlene R Melk |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578523338 PECOS PAC ID: 4587693957 Enrollment ID: I20050805000397 |
| Provider Name | Andrew W Mayberry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629019260 PECOS PAC ID: 4385657014 Enrollment ID: I20060726000029 |
| Provider Name | Jonathan P Melk |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568496164 PECOS PAC ID: 4385647775 Enrollment ID: I20060920000052 |
| Provider Name | Gitakrishna Balakumar |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700941408 PECOS PAC ID: 2466530704 Enrollment ID: I20090916000169 |
| Provider Name | Dia C Madden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215241518 PECOS PAC ID: 2668667122 Enrollment ID: I20101109001574 |
| Provider Name | Milla S Rosen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144289760 PECOS PAC ID: 8820285885 Enrollment ID: I20101203000418 |
| Provider Name | Tammy L Posey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760784342 PECOS PAC ID: 2567613482 Enrollment ID: I20121127000068 |
| Provider Name | Steven Kenneth Dahlke |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710976337 PECOS PAC ID: 5496908295 Enrollment ID: I20150515001286 |
| Provider Name | Tamika M Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770814790 PECOS PAC ID: 0143444851 Enrollment ID: I20150724010804 |
| Provider Name | Nori Ruo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710922018 PECOS PAC ID: 7113232604 Enrollment ID: I20150812008395 |
| Provider Name | Kerstin P Hurley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710342043 PECOS PAC ID: 7911203062 Enrollment ID: I20160315002874 |
| Provider Name | Karina C Bechtold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598129454 PECOS PAC ID: 5597064204 Enrollment ID: I20160502001731 |
| Provider Name | Tonya L Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679825152 PECOS PAC ID: 7214152206 Enrollment ID: I20160725001700 |
| Provider Name | Lisa N Tant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356899793 PECOS PAC ID: 9436447943 Enrollment ID: I20161017002095 |
| Provider Name | Eduardo a Marrero Velis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1144560160 PECOS PAC ID: 3476841818 Enrollment ID: I20161018000627 |
| Provider Name | Claudia Patricia Pleitez Tecun |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710388954 PECOS PAC ID: 1557665106 Enrollment ID: I20161018002585 |
| Provider Name | Pamela Catherine Oliphant |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1174072326 PECOS PAC ID: 1658650882 Enrollment ID: I20161110002565 |
| Provider Name | Jeffrey Richard Holzberg |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1235556168 PECOS PAC ID: 7416279237 Enrollment ID: I20170914002407 |
| Provider Name | Jennifer H Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366601932 PECOS PAC ID: 5991830499 Enrollment ID: I20180221001791 |
| Provider Name | Chelsey M Housley |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1467954594 PECOS PAC ID: 3870855190 Enrollment ID: I20180327001399 |
| Provider Name | Christine R Grassman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689111817 PECOS PAC ID: 1052676939 Enrollment ID: I20180523002741 |
| Provider Name | Daniel a Driscoll |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689744591 PECOS PAC ID: 2365480019 Enrollment ID: I20180730000258 |
| Provider Name | Gustavo Durazo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427600782 PECOS PAC ID: 4385078799 Enrollment ID: I20191217003291 |
| Provider Name | Joshua Jean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891236220 PECOS PAC ID: 0042567836 Enrollment ID: I20201016001865 |
| Provider Name | Glenn David Tanita |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669632006 PECOS PAC ID: 6002705977 Enrollment ID: I20211124001606 |
| Provider Name | Heather L Kinder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295240885 PECOS PAC ID: 3870983349 Enrollment ID: I20211124001746 |
| Provider Name | Kirsten Nicole Mellott |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1891368452 PECOS PAC ID: 7012312978 Enrollment ID: I20211208002953 |
| Provider Name | Jonathan Howell Rutherford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154091932 PECOS PAC ID: 1456744341 Enrollment ID: I20220217002193 |
| Provider Name | Victoria L Ochoa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841946183 PECOS PAC ID: 0042607541 Enrollment ID: I20220520001274 |
| Provider Name | Gino Jose Bardi Lola |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700230109 PECOS PAC ID: 3971830464 Enrollment ID: I20220615001320 |
| Provider Name | Chine Quetzalcoatl Tan Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295453165 PECOS PAC ID: 5698151967 Enrollment ID: I20221011000347 |
| Provider Name | Dana J Albalate |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1124736467 PECOS PAC ID: 1951772094 Enrollment ID: I20230127000418 |
| Provider Name | Deanna Lee Merrill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396345955 PECOS PAC ID: 3971976176 Enrollment ID: I20230309001665 |
| Provider Name | Lilia Lara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073231742 PECOS PAC ID: 7517331036 Enrollment ID: I20230324000948 |
| Provider Name | Rebecca Satter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467097295 PECOS PAC ID: 0648643643 Enrollment ID: I20230515002856 |
| Provider Name | Jamie Lynn Fitzpatrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467145904 PECOS PAC ID: 8123487758 Enrollment ID: I20230629002973 |
| Provider Name | Catherine Khanh-an Vu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437779238 PECOS PAC ID: 6305290644 Enrollment ID: I20230920003349 |
| Provider Name | Gavelyn Poonnopatam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962021378 PECOS PAC ID: 0547614984 Enrollment ID: I20231003003602 |
| Provider Name | Patrick Donald Thurber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265114037 PECOS PAC ID: 7113372855 Enrollment ID: I20231016001792 |
| Provider Name | Jana Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174201511 PECOS PAC ID: 7416305990 Enrollment ID: I20231121003175 |
| Provider Name | Angelica M Bennett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578234340 PECOS PAC ID: 7618329970 Enrollment ID: I20240123000934 |
| Provider Name | Sherri Arenas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386187680 PECOS PAC ID: 1052757440 Enrollment ID: I20240307002295 |
| Provider Name | Ana Rebecca Toothman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1831488642 PECOS PAC ID: 1456798354 Enrollment ID: I20240327003593 |
| Provider Name | Larry Corrales |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154080125 PECOS PAC ID: 3173067154 Enrollment ID: I20240701003821 |
| Provider Name | Nancy J Sabat |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710946553 PECOS PAC ID: 7315941481 Enrollment ID: I20240719000286 |
| Provider Name | Jessica Lynn Crewse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225863780 PECOS PAC ID: 4981135233 Enrollment ID: I20240927001247 |
| Provider Name | Kathryn Sue Henley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538175211 PECOS PAC ID: 7012915309 Enrollment ID: I20241011001447 |
| Provider Name | Scott L Lacy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740790856 PECOS PAC ID: 2365976685 Enrollment ID: I20241108003384 |
| Provider Name | Jazmine Aglae Morales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003558065 PECOS PAC ID: 4284168493 Enrollment ID: I20241111003227 |
| Provider Name | Paulina Moreno Guillen |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1225840408 PECOS PAC ID: 2961922133 Enrollment ID: I20250219001342 |
| Provider Name | Ange M Pompee Synsmir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447431697 PECOS PAC ID: 3971689829 Enrollment ID: I20250228002361 |
| Provider Name | Elizabeth Grijalva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942059993 PECOS PAC ID: 7719498393 Enrollment ID: I20250619002160 |
| Provider Name | Polly P Lund |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851018147 PECOS PAC ID: 8729510375 Enrollment ID: I20250922003396 |
| Provider Name | Olivia Nicole Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992473748 PECOS PAC ID: 4880181213 Enrollment ID: I20251017001525 |
| Provider Name | Amy Lynn Gabrielski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285965921 PECOS PAC ID: 6406173871 Enrollment ID: I20260115002424 |
| Provider Name | Veronica Asalia Allard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346966595 PECOS PAC ID: 7911476668 Enrollment ID: I20260512002929 |
| Provider Name | Karina Bethany Vidal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386428258 PECOS PAC ID: 6507338373 Enrollment ID: I20260611004723 |
Red Canyon Infectious Disease Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2174 W Oak Ave, Douglas, AZ 85607 Phone: 520-366-0335 Fax: 520-366-0388 |
Douglas Acute Care, Laboratory, and Pharmacy Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1111 N F Ave, Douglas, AZ 85607 Phone: 520-364-1429 |
Chiricahua Community Health Centers, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 815 15th Street, Douglas, AZ 85607 Phone: 520-364-5437 Fax: 520-364-4261 |
Douglas Family Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1101 N San Antonio Ave, Douglas, AZ 85607 Phone: 520-417-3001 Fax: 520-417-3297 |
Community Healthcare of Douglas Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2174 W Oak Ave, Douglas, AZ 85607 Phone: 520-364-7931 Fax: 520-364-2551 |
Douglas Family Care PLLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1906 E 11th St, Douglas, AZ 85607 Phone: 520-364-1120 Fax: 520-364-6417 |