| Arizona | |
|
15333 N Pima Rd Ste 305 Scottsdale AZ 85260-2717 | |
| (657) 400-5180 | |
| Not Available |
| Full Name | Arizona |
|---|---|
| Speciality | General Practice |
| Location | 15333 N Pima Rd Ste 305, Scottsdale, Arizona |
| Authorized Official Name and Position | Christopher Dennis (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 6574005180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arizona 7755 Center Ave Ste 630 Huntington Beach CA 92647-9152 Ph: () - | Arizona 15333 N Pima Rd Ste 305 Scottsdale AZ 85260-2717 Ph: (657) 400-5180 |
| NPI Number | 1144944398 |
|---|---|
| Provider Enumeration Date | 09/30/2022 |
| Last Update Date | 01/30/2024 |
| Medicare PECOS PAC ID | 8527453851 |
|---|---|
| Medicare Enrollment ID | O20221213002913 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144944398 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Pamela Sullivan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326191107 PECOS PAC ID: 6305886011 Enrollment ID: I20221228001843 |
| Provider Name | Anaidra Reese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104476423 PECOS PAC ID: 4587098959 Enrollment ID: I20230208001217 |
| Provider Name | Lena Jeanelle Gamble |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629312566 PECOS PAC ID: 5991082737 Enrollment ID: I20230420001836 |
| Provider Name | John Eikens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104844604 PECOS PAC ID: 6103832944 Enrollment ID: I20230628001698 |
| Provider Name | Mercedes Rivera Barber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386913242 PECOS PAC ID: 1850681842 Enrollment ID: I20230711003043 |
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