| Family Tree Healthcare Llc | |
|
7002 S Central Ave Phoenix AZ 85042-5423 | |
| (602) 449-4221 | |
| (602) 268-6298 |
| Full Name | Family Tree Healthcare Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7002 S Central Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Hector Reyes (PRESIDENT CLINIC OPERATIONS) |
| Authorized Official Contact | 6024994221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Tree Healthcare Llc 7002 S Central Ave Phoenix AZ 85042-5423 Ph: (602) 449-4221 | Family Tree Healthcare Llc 7002 S Central Ave Phoenix AZ 85042-5423 Ph: (602) 449-4221 |
| NPI Number | 1336500636 |
|---|---|
| Provider Enumeration Date | 03/14/2016 |
| Last Update Date | 05/07/2025 |
| Medicare PECOS PAC ID | 7517240567 |
|---|---|
| Medicare Enrollment ID | O20170216002682 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336500636 | NPI | - | NPPES |
| 028879 | Medicaid | AZ | |
| 854053 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Edmond L Baker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1235304171 PECOS PAC ID: 1850444233 Enrollment ID: I20100114000343 |
| Provider Name | Delana Gardner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497181705 PECOS PAC ID: 8729207725 Enrollment ID: I20140923001992 |
| Provider Name | Lawanda M Dupree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760874168 PECOS PAC ID: 7315259769 Enrollment ID: I20150629000436 |
| Provider Name | Elicia B Hinton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922644012 PECOS PAC ID: 3971920562 Enrollment ID: I20200827001637 |
| Provider Name | Alina Moayer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366124638 PECOS PAC ID: 9638524473 Enrollment ID: I20231013000539 |
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