MEDICARE: MCKELLIPS FAMILY MEDICAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	2244	AZ

General Provider Information

NPI Number	:	1962938175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKELLIPS FAMILY MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	3514 N POWER RD
Second Line	:	105
City	:	MESA
State	:	AZ
Zip	:	85215
Country	:	US
Telephone Number	:	480-422-8566
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 N POWER RD
Second Line	:	105
City	:	MESA
State	:	AZ
Zip	:	85215-2903
Country	:	US
Telephone Number	:	480-422-8533
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANGER
Name	:	SABRINA MONTANEZ
Credential	:
Telephone Number	:	480-422-8533

Provider Enumeration Date	:	05/08/2017
Last Update Date	:	05/08/2017

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