| Grapevine Clinic Llc | |
|
5300 S Highway 95 Suite H Fort Mohave AZ 86426-9251 | |
| (928) 788-6060 | |
| (928) 788-6062 |
| Full Name | Grapevine Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5300 S Highway 95, Fort Mohave, Arizona |
| Authorized Official Name and Position | Kaye A Cunningham (OWNER/MEMBER) |
| Authorized Official Contact | 9287886060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grapevine Clinic Llc Po Box 8670 Fort Mohave AZ 86427-8670 Ph: (928) 788-6060 | Grapevine Clinic Llc 5300 S Highway 95 Suite H Fort Mohave AZ 86426-9251 Ph: (928) 788-6060 |
| NPI Number | 1164731030 |
|---|---|
| Provider Enumeration Date | 09/27/2010 |
| Last Update Date | 09/27/2010 |
| Medicare PECOS PAC ID | 6800089889 |
|---|---|
| Medicare Enrollment ID | O20101022000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164731030 | NPI | - | NPPES |
| L-16288258 | Other | AZ | ARIZONA LLC REGISTRATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 28326 (Arizona) | Primary |
| Provider Name | Kaye A Cunningham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447435417 PECOS PAC ID: 8527049337 Enrollment ID: I20101204000079 |
Vista Health Mirza Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5653 S Highway 95, Ste A, Fort Mohave, AZ 86426 Phone: 928-768-2558 Fax: 928-768-2874 | |
Mohave Family Healthcare Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1611 E Joy Ln, Fort Mohave, AZ 86426 Phone: 928-768-9496 Fax: 928-768-1943 | |
Kaye A Cunningham Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5653 Hwy 95, Suite A, Fort Mohave, AZ 86426 Phone: 928-768-2558 Fax: 928-788-2039 | |
Gi Institute Of Arizona Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1520 E Hammer Ln Ste 101, Fort Mohave, AZ 86426 Phone: 928-768-4333 Fax: 928-768-4338 | |
Blue River Health & Wellness, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1520 E Hammer Ln Ste 104, Fort Mohave, AZ 86426 Phone: 602-315-0211 | |
Hendrix Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1611 Joy Ln, Fort Mohave, AZ 86426 Phone: 928-788-1900 Fax: 928-788-2048 |