MEDICARE: FREDERICK MCLEAN BRINCKERHOFF

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	253Z00000X	In Home Supportive Care Agency		AZ

General Provider Information

NPI Number	:	1265304299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK MCLEAN BRINCKERHOFF

Provider Business Mailing Address
First Line	:	3038 E FORT LOWELL RD STE 5
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1501
Country	:	US
Telephone Number	:	520-795-8286
Fax Number	:

Provider Business Practice Location Address
First Line	:	3038 E FORT LOWELL RD STE 5
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1501
Country	:	US
Telephone Number	:	520-471-1506
Fax Number	:

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

Provider Enumeration Date	:	09/19/2025
Last Update Date	:	09/19/2025

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