| Versatile Medicine PLLC | |
|
13055 W Mcdowell Rd Suite E-106 Avondale AZ 85392-6449 | |
| (623) 975-8400 | |
| (623) 935-2975 |
| Full Name | Versatile Medicine PLLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 13055 W Mcdowell Rd, Avondale, Arizona |
| Authorized Official Name and Position | Kathleen a Nichols (PHYSICIAN/GENERAL MANAGER) |
| Authorized Official Contact | 6239758400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Versatile Medicine PLLC 13055 W Mcdowell Rd Suite E-106 Avondale AZ 85392-6449 Ph: (623) 975-8400 | Versatile Medicine PLLC 13055 W Mcdowell Rd Suite E-106 Avondale AZ 85392-6449 Ph: (623) 975-8400 |
| NPI Number | 1326145608 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 06/08/2015 |
| Medicare PECOS PAC ID | 3274597133 |
|---|---|
| Medicare Enrollment ID | O20041119000233 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326145608 | NPI | - | NPPES |
| AZ0761300 | Other | AZ | BLUE CROSS BLUE SHIELD |
| AZ0765500 | Other | AZ | BLUE CROSS BLUE SHIELD |
| 517675 | Medicaid | AZ | |
| 486581001 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | AZ26993 (Arizona) | Primary |
| Provider Name | Kathleen a Nichols |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245241215 PECOS PAC ID: 5698743078 Enrollment ID: I20040923000179 |
| Provider Name | Terry Hicks Woodbeck |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891706875 PECOS PAC ID: 5991734188 Enrollment ID: I20050808001090 |
| Provider Name | Miranda K Gruenberg |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1841444734 PECOS PAC ID: 6507053568 Enrollment ID: I20101203000371 |
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