MEDICARE: GILA HEALTH AND WELLNESS CENTER LLC

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	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1366134835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILA HEALTH AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	616 S BEELINE HWY STE 101
Second Line	:
City	:	PAYSON
State	:	AZ
Zip	:	85541-5380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 S BEELINE HWY STE 101
Second Line	:
City	:	PAYSON
State	:	AZ
Zip	:	85541-5380
Country	:	US
Telephone Number	:	602-706-4405
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NAIM ROBINSON
Credential	:
Telephone Number	:	602-706-4405

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	05/23/2023

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