| Grand Canyon Medical Clinic Pllc | |
|
1841 W 25th St Ste B Yuma AZ 85364-6931 | |
| (928) 503-7246 | |
| Not Available |
| Full Name | Grand Canyon Medical Clinic Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1841 W 25th St Ste B, Yuma, Arizona |
| Authorized Official Name and Position | Alex D Galvez (OWNER) |
| Authorized Official Contact | 9283508507 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Canyon Medical Clinic Pllc 1329 W 20th St Yuma AZ 85364-5321 Ph: (928) 503-7246 | Grand Canyon Medical Clinic Pllc 1841 W 25th St Ste B Yuma AZ 85364-6931 Ph: (928) 503-7246 |
| NPI Number | 1164141065 |
|---|---|
| Provider Enumeration Date | 08/24/2022 |
| Last Update Date | 02/20/2024 |
| Medicare PECOS PAC ID | 5799151411 |
|---|---|
| Medicare Enrollment ID | O20240208003718 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164141065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Alex D Galvez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871956466 PECOS PAC ID: 4688973431 Enrollment ID: I20160428000894 |
| Provider Name | Jared E Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245876499 PECOS PAC ID: 3870920721 Enrollment ID: I20200323001864 |
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