MEDICARE: CLEARPATH FAMILY HEALTH LTD

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	261QP2300X	Primary Care Clinic/Center	1647	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Z137678	OTHER		PTAN

General Provider Information

NPI Number	:	1225356157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARPATH FAMILY HEALTH LTD

Provider Business Mailing Address
First Line	:	7725 N 43RD AVE STE 720
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5772
Country	:	US
Telephone Number	:	623-207-5465
Fax Number	:	623-207-5405

Provider Business Practice Location Address
First Line	:	7725 N 43RD AVE STE 720
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5772
Country	:	US
Telephone Number	:	623-207-5465
Fax Number	:	623-207-5405

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAUN C A ROMERO
Credential	:
Telephone Number	:	602-819-9608

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	10/09/2020

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