Walker Family Medicine PLC
Organization Active NPI Family Medicine Physician · Portal, AZ
NPI 1962775296 · NPPES record last updated Feb 16, 2012
Key facts
- NPI
- 1962775296
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 3240 (AZ)
- Legal business name
- WALKER FAMILY MEDICINE PLC
- Practice address
- 2391 S Rock House Rd
Portal, AZ 85632-9950 - Phone
- (520) 766-5000
- NPI assigned
- Feb 16, 2012
- Organization subpart
- No
Authorized official
- Name
- Joe Walker
- Title
- Business Manager
- Phone
- (520) 766-5000
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 1
Practitioners 8
-
Amanda Dawn Bennett, FNP-C
-
Amanda Ann Davis, NP
-
Frances Weaver Grill, FNP
-
Julie Anne Hilton, ACNP-BC,FNP-C
-
Mark M Lessner, M.D.
-
Mick Gene Drage, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080222000388 | AZ | Part B Supplier - Clinic/Group Practice | 1557445004 |
Receives reassigned benefits from 7 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Portal, AZ; Wilcox, AZ |
National Provider Directory
- Tax ID family
- Walker Family Medicine
Locations
1103 E Irene St
Sunsites, AZ 85625
Phone (520) 766-5000
801 W Rex Allen Dr
Willcox, AZ 85643
Phone (520) 766-5000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 3240 | AZ | Yes |
Addresses
Primary practice location
2391 S Rock House Rd
Portal, AZ 85632-9950
Mailing address
801 W Rex Allen Dr
Willcox, AZ 85643-1129
Phone (520) 766-5000
Other providers in Portal, AZ
All providers in Portal, AZ · Family 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 Feb 16, 2012. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.