| Everest Medical Group | |
|
4864 E Baseline Rd Ste 105 Mesa AZ 85206-4629 | |
| (480) 558-1900 | |
| (480) 633-6086 |
| Full Name | Everest Medical Group |
|---|---|
| Speciality | General Practice |
| Location | 4864 E Baseline Rd Ste 105, Mesa, Arizona |
| Authorized Official Name and Position | Ty Ruddell (CEO) |
| Authorized Official Contact | 4805109475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Everest Medical Group 4864 E Baseline Rd Ste 105 Mesa AZ 85206-4629 Ph: (480) 558-1900 | Everest Medical Group 4864 E Baseline Rd Ste 105 Mesa AZ 85206-4629 Ph: (480) 558-1900 |
| NPI Number | 1184103350 |
|---|---|
| Provider Enumeration Date | 08/08/2018 |
| Last Update Date | 08/08/2018 |
| Medicare PECOS PAC ID | 8426309477 |
|---|---|
| Medicare Enrollment ID | O20181001003314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184103350 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Ty S Ruddell |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1982767349 PECOS PAC ID: 9032137062 Enrollment ID: I20051108000362 |
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