| White Tank Medical Pllc | |
|
18761 N Reems Rd Ste 400 Surprise AZ 85374-8646 | |
| (623) 583-9180 | |
| Not Available |
| Full Name | White Tank Medical Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 18761 N Reems Rd Ste 400, Surprise, Arizona |
| Authorized Official Name and Position | Justin James Woodside (OWNER) |
| Authorized Official Contact | 6235839180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| White Tank Medical Pllc 18761 N Reems Rd Ste 400 Surprise AZ 85374-8646 Ph: () - | White Tank Medical Pllc 18761 N Reems Rd Ste 400 Surprise AZ 85374-8646 Ph: (623) 583-9180 |
| NPI Number | 1306549837 |
|---|---|
| Provider Enumeration Date | 03/23/2023 |
| Last Update Date | 03/23/2023 |
| Medicare PECOS PAC ID | 1759746704 |
|---|---|
| Medicare Enrollment ID | O20230427000829 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306549837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Frank B Hatch |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1235297144 PECOS PAC ID: 6901845312 Enrollment ID: I20050426001077 |
| Provider Name | Jacob Healey |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1578844874 PECOS PAC ID: 3779758073 Enrollment ID: I20111215000337 |
| Provider Name | Robert R Wolfe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023660065 PECOS PAC ID: 9436481348 Enrollment ID: I20191025002124 |
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