| Lifetime Medical Care Pllc | |
|
3101 Clearwater Dr Suite B Prescott AZ 86305-7180 | |
| (928) 237-9014 | |
| (928) 237-9063 |
| Full Name | Lifetime Medical Care Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3101 Clearwater Dr, Prescott, Arizona |
| Authorized Official Name and Position | Shelly Damschroder (MANAGER/OWNER/PROVIDER) |
| Authorized Official Contact | 9282379014 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Medical Care Pllc 3101 Clearwater Dr Suite B Prescott AZ 86305-7180 Ph: (928) 237-9014 | Lifetime Medical Care Pllc 3101 Clearwater Dr Suite B Prescott AZ 86305-7180 Ph: (928) 237-9014 |
| NPI Number | 1265840037 |
|---|---|
| Provider Enumeration Date | 07/24/2014 |
| Last Update Date | 01/04/2015 |
| Medicare PECOS PAC ID | 5890914170 |
|---|---|
| Medicare Enrollment ID | O20140918001503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265840037 | NPI | - | NPPES |
| AP7289 | Other | AZ | NURSE PRACTITIONER LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | AP7289 (Arizona) | Primary |
| Provider Name | Shelly Damschroder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164750923 PECOS PAC ID: 6709005085 Enrollment ID: I20140918001777 |
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