MEDICARE: VOYAGER WELLNESS CLINIC, INC

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	261Q00000X	Clinic/Center	10-103256-A	AZ

General Provider Information

NPI Number	:	1992880173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOYAGER WELLNESS CLINIC, INC

Provider Business Mailing Address
First Line	:	8701 S KOLB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-9607
Country	:	US
Telephone Number	:	520-547-6046
Fax Number	:	520-574-6048

Provider Business Practice Location Address
First Line	:	8701 S KOLB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-9607
Country	:	US
Telephone Number	:	520-547-6046
Fax Number	:	520-574-6048

Authorized Official
Title or Position	:	OWNER
Name	:	IKE ISAACSON
Credential	:
Telephone Number	:	520-574-5003

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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