| Desert Horizon Internal Medicine | |
|
2501 E Southern Ave Suite 4 Tempe AZ 85282-7669 | |
| (520) 421-1122 | |
| (520) 421-0751 |
| Full Name | Desert Horizon Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 2501 E Southern Ave, Tempe, Arizona |
| Authorized Official Name and Position | Frederick Stack (OWNER/ PROVIDER) |
| Authorized Official Contact | 5204211122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Horizon Internal Medicine Po Box 13410 Chandler AZ 85248-0041 Ph: (520) 421-1122 | Desert Horizon Internal Medicine 2501 E Southern Ave Suite 4 Tempe AZ 85282-7669 Ph: (520) 421-1122 |
| NPI Number | 1982735031 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 09/18/2015 |
| Medicare PECOS PAC ID | 2062499072 |
|---|---|
| Medicare Enrollment ID | O20040707000439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982735031 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Frederick R Stack |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548256977 PECOS PAC ID: 9638149230 Enrollment ID: I20040730000095 |
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