| Optimal Mens Center PLLC | |
|
700 N Estrella Pkwy Ste 145 Goodyear AZ 85338-9329 | |
| (602) 678-4625 | |
| Not Available |
| Full Name | Optimal Mens Center PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 700 N Estrella Pkwy Ste 145, Goodyear, Arizona |
| Authorized Official Name and Position | Kerry Knight (PARTNER) |
| Authorized Official Contact | 6236404973 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Mens Center PLLC 700 N Estrella Pkwy Ste 145 Goodyear AZ 85338-9329 | Optimal Mens Center PLLC 700 N Estrella Pkwy Ste 145 Goodyear AZ 85338-9329 Ph: (602) 678-4625 |
| NPI Number | 1811535974 |
|---|---|
| Provider Enumeration Date | 12/19/2019 |
| Last Update Date | 12/19/2019 |
| Certification Date | 12/19/2019 |
| Medicare PECOS PAC ID | 7113356460 |
|---|---|
| Medicare Enrollment ID | O20200407003439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811535974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Nasser Hajaig |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457324204 PECOS PAC ID: 6800788787 Enrollment ID: I20040708000751 |
| Provider Name | Kerry M Knight |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194730762 PECOS PAC ID: 9032123195 Enrollment ID: I20060127000842 |
| Provider Name | Trent W Knight |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1366695470 PECOS PAC ID: 3375699507 Enrollment ID: I20090914000190 |
| Provider Name | Ran Mcbryde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841760766 PECOS PAC ID: 8123367919 Enrollment ID: I20190221001730 |
| Provider Name | Cynthia Dianne Reed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750585782 PECOS PAC ID: 0941431514 Enrollment ID: I20190425001668 |
| Provider Name | Boris Boguslavskiy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689075509 PECOS PAC ID: 7719208602 Enrollment ID: I20190607000687 |
| Provider Name | Mitzi Schardt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821267816 PECOS PAC ID: 9537518782 Enrollment ID: I20231213000696 |
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