MEDICARE: DIMECA CALVERT CPT

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	246RP1900X	Phlebotomy Technician		AZ

General Provider Information

NPI Number	:	1164380416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMECA CALVERT CPT

Provider Business Mailing Address
First Line	:	820 W COTTONWOOD LN STE 9
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-2239
Country	:	US
Telephone Number	:	602-737-3001
Fax Number	:	231-241-9677

Provider Business Practice Location Address
First Line	:	820 W COTTONWOOD LN STE 9
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-2239
Country	:	US
Telephone Number	:	602-737-3001
Fax Number	:	231-241-9677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ DIMECA CALVERT CPT” Practice Location

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