| O Longevity & Wellness, Pllc | |
|
9821 N 95th St Ste 101 Scottsdale AZ 85258-4589 | |
| (480) 416-0403 | |
| (480) 240-5467 |
| Full Name | O Longevity & Wellness, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 9821 N 95th St Ste 101, Scottsdale, Arizona |
| Authorized Official Name and Position | Ken Shadman Ota (PHYSICIAN) |
| Authorized Official Contact | 4803658035 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| O Longevity & Wellness, Pllc 9821 N 95th St Ste 101 Scottsdale AZ 85258-4589 Ph: (480) 365-8035 | O Longevity & Wellness, Pllc 9821 N 95th St Ste 101 Scottsdale AZ 85258-4589 Ph: (480) 416-0403 |
| NPI Number | 1083111371 |
|---|---|
| Provider Enumeration Date | 04/12/2018 |
| Last Update Date | 08/30/2019 |
| Medicare PECOS PAC ID | 2961735550 |
|---|---|
| Medicare Enrollment ID | O20190613002015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083111371 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5305 (Arizona) | Primary |
| Provider Name | Ken S Ota |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750544276 PECOS PAC ID: 2365635935 Enrollment ID: I20101015000585 |
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