| Desert Life Primary Care Llc | |
|
3035 S Ellsworth Rd Ste 121 Mesa AZ 85212-2137 | |
| (480) 280-7229 | |
| Not Available |
| Full Name | Desert Life Primary Care Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 3035 S Ellsworth Rd Ste 121, Mesa, Arizona |
| Authorized Official Name and Position | John Woodham (OWNER) |
| Authorized Official Contact | 7604644944 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Life Primary Care Llc 3035 S Ellsworth Rd Ste 121 Mesa AZ 85212-2137 Ph: () - | Desert Life Primary Care Llc 3035 S Ellsworth Rd Ste 121 Mesa AZ 85212-2137 Ph: (480) 280-7229 |
| NPI Number | 1649943655 |
|---|---|
| Provider Enumeration Date | 07/26/2021 |
| Last Update Date | 11/17/2021 |
| Medicare PECOS PAC ID | 1052701232 |
|---|---|
| Medicare Enrollment ID | O20211201003060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649943655 | NPI | - | NPPES |
| Provider Name | Shirene Woodham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326527508 PECOS PAC ID: 3274863139 Enrollment ID: I20190919002691 |
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