MEDICARE: PGF MEDICAL SERVICES PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207QA0401X	Addiction Medicine (Family Medicine) Physician
2	2083A0300X	Addiction Medicine (Preventive Medicine) Physician
3	146D00000X	Personal Emergency Response Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3162	OTHER	AZ	STATE LICENSE

General Provider Information

NPI Number	:	1356857262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PGF MEDICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	5656 E ORANGE BLOSSOM LN STE 5
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-8139
Country	:	US
Telephone Number	:	602-601-7429
Fax Number	:	602-601-7428

Provider Business Practice Location Address
First Line	:	5656 E ORANGE BLOSSOM LN STE 5
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-8139
Country	:	US
Telephone Number	:	602-601-7429
Fax Number	:	602-601-7428

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL G. FLATLEY
Credential	:	DO
Telephone Number	:	602-601-7430

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	08/04/2021

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Directions to “PGF MEDICAL SERVICES PLLC ” Practice Location

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