Agape Clinic Inc
Organization Active NPI Adult Medicine Physician · Yuma, AZ
NPI 1922720333 · NPPES record last updated Sep 13, 2022
Key facts
- NPI
- 1922720333
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Medicine Physician 207QA0505X
- Legal business name
- AGAPE CLINIC INC
- Practice address
- 2140 W 24TH St Ste B
Yuma, AZ 85364-8877 - Phone
- (928) 459-3400
- Fax
- (928) 459-2077
- NPI assigned
- Sep 13, 2022
- Organization subpart
- No
Authorized official
- Name
- Mr. John Ernest Williams
- Title
- Executive Director
- Phone
- (928) 459-3400
Practitioners 3
-
Peter Dashkoff, M.D.
-
Danielle Lynn Miller, CRNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2281298 | Agape Clinic Inc | Certificate of waiver | May 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231017002975 | AZ | Part B Supplier - Clinic/Group Practice | 1153776729 |
Receives reassigned benefits from 3 practitioners Practice locations: Yuma, AZ |
National Provider Directory
Locations
2140 W 24th St
Ste B
Yuma, AZ 85364
Phone (928) 459-3400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician |
207QA0505X | Yes | ||
| Geriatric Medicine (Family Medicine) Physician |
207QG0300X | |||
| Adult Health Nurse Practitioner |
363LA2200X | |||
| Gerontology Nurse Practitioner |
363LG0600X |
Addresses
Primary practice location
2140 W 24TH St Ste B
Yuma, AZ 85364-8877
Mailing address
2140 W 24TH St Ste B
Yuma, AZ 85364-8877
Phone (928) 503-4060
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Citrix | Health Information Exchange (HIE) | Yuma Regional Medical Center |
Other providers in Yuma, AZ
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- Affordable Counseling of Yuma
- Ana Aguayo
- Rinely Aguiar-Olsen
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- Perla Aguilar
- Elsa Doreen Aguirre
All providers in Yuma, AZ · Adult Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.