| Kachina Family Practice Pa | |
|
16611 S 40th St Suite 120 Phoenix AZ 85048 | |
| (480) 706-4100 | |
| (480) 706-2600 |
| Full Name | Kachina Family Practice Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 16611 S 40th St, Phoenix, Arizona |
| Authorized Official Name and Position | Jaron Joseph Fischbeck (PRESIDENT) |
| Authorized Official Contact | 4807064100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kachina Family Practice Pa 16611 S 40th St Suite 120 Phoenix AZ 85048 Ph: (480) 706-4100 | Kachina Family Practice Pa 16611 S 40th St Suite 120 Phoenix AZ 85048 Ph: (480) 706-4100 |
| NPI Number | 1467508432 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 04/30/2020 |
| Medicare PECOS PAC ID | 3274427802 |
|---|---|
| Medicare Enrollment ID | O20040212000697 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467508432 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jaron J Fischbeck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760497325 PECOS PAC ID: 1658399654 Enrollment ID: I20051108000947 |
| Provider Name | Robert Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144859307 PECOS PAC ID: 2769802271 Enrollment ID: I20230627000517 |
| Provider Name | Bridget Natalie Blansfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679250393 PECOS PAC ID: 8325401029 Enrollment ID: I20230829001248 |
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