| Leading Edge Medical | |
|
1530 S Val Vista Dr Ste 106 Gilbert AZ 85296-3860 | |
| (480) 664-6061 | |
| (480) 584-6336 |
| Full Name | Leading Edge Medical |
|---|---|
| Speciality | General Practice |
| Location | 1530 S Val Vista Dr Ste 106, Gilbert, Arizona |
| Authorized Official Name and Position | Benjamin Johnson (OWNER) |
| Authorized Official Contact | 4806646061 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leading Edge Medical 1530 S Val Vista Dr Ste 106 Gilbert AZ 85296-3860 Ph: (480) 664-6061 | Leading Edge Medical 1530 S Val Vista Dr Ste 106 Gilbert AZ 85296-3860 Ph: (480) 664-6061 |
| NPI Number | 1861915688 |
|---|---|
| Provider Enumeration Date | 07/24/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 8224396874 |
|---|---|
| Medicare Enrollment ID | O20180103001758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861915688 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Samantha Nazaroff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467975698 PECOS PAC ID: 0345507844 Enrollment ID: I20171207001474 |
| Provider Name | Tammatha Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417439274 PECOS PAC ID: 0547505984 Enrollment ID: I20181213000553 |
| Provider Name | Samantha Jo Christman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033799465 PECOS PAC ID: 4688066970 Enrollment ID: I20220118002665 |
| Provider Name | Ashley Ann Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235883935 PECOS PAC ID: 4486036217 Enrollment ID: I20220727003173 |
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