| Teresa J Tibbetts M D Llc | |
|
2082 Mesquite Ave Suite A106 Lake Havasu City AZ 86403-6710 | |
| (928) 680-4233 | |
| (928) 680-6522 |
| Full Name | Teresa J Tibbetts M D Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2082 Mesquite Ave, Lake Havasu City, Arizona |
| Authorized Official Name and Position | Teresa J Tibbetts (OWNER) |
| Authorized Official Contact | 9286804233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Teresa J Tibbetts M D Llc Po Box 2325 Lake Havasu City AZ 86405-2325 Ph: (928) 680-4233 | Teresa J Tibbetts M D Llc 2082 Mesquite Ave Suite A106 Lake Havasu City AZ 86403-6710 Ph: (928) 680-4233 |
| NPI Number | 1053594275 |
|---|---|
| Provider Enumeration Date | 12/11/2007 |
| Last Update Date | 08/05/2008 |
| Medicare PECOS PAC ID | 5294773073 |
|---|---|
| Medicare Enrollment ID | O20050421000943 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053594275 | NPI | - | NPPES |
| 474429 | Medicaid | AZ | |
| AZ0769200 | Other | BCBS AZ | |
| 2Z2286 | Other | HEALTH NET | |
| DD0854 | Other | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 27163 (Arizona) | Primary |
| Provider Name | Teresa J Tibbetts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750486445 PECOS PAC ID: 7517955313 Enrollment ID: I20040501000473 |
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