| Desert Palm Mat | |
|
1021 E Palmdale St Ste 130 Tucson AZ 85714-1859 | |
| (520) 407-5353 | |
| (520) 318-6917 |
| Full Name | Desert Palm Mat |
|---|---|
| Speciality | Clinic/Center |
| Location | 1021 E Palmdale St Ste 130, Tucson, Arizona |
| Authorized Official Name and Position | Rose Mary Lopez (PRESIDENT AND CEO) |
| Authorized Official Contact | 5207211887 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Palm Mat Po Box 86537 Tucson AZ 85754-6537 Ph: (520) 721-1887 | Desert Palm Mat 1021 E Palmdale St Ste 130 Tucson AZ 85714-1859 Ph: (520) 407-5353 |
| NPI Number | 1457841678 |
|---|---|
| Provider Enumeration Date | 05/14/2018 |
| Last Update Date | 04/20/2020 |
| Certification Date | 04/20/2020 |
| Medicare PECOS PAC ID | 7315163938 |
|---|---|
| Medicare Enrollment ID | O20200924000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457841678 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | () | Secondary |
| 261QM2800X | Clinic/center - Methadone | PENDING (Arizona) | Primary |
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