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Christopher Leigh Fullmer

Student in an Organized Health Care Education/Training Program

Student, Health Care

19555 N 59th Ave, Glendale, AZ 85308-6813

PECOS Enrollment

This provider is enrolled in PECOS as CHRISTOPHER FULLMER.

Based on the most recent information from CMS, provider Christopher Leigh Fullmer is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1053012831
Provider Type
Individual
Full Name
Fullmer, Christopher Leigh
Gender
Male

Sole Proprietor
Yes
Enumeration Date
3/17/2023
Last Updated
3/17/2023

Contact Information

Practice Location

19555 N 59th Ave, Glendale, AZ 85308-6813

(653) 572-3200

Unlisted Fax

Mailing Location

3826 W Michelle Dr, Glendale, AZ 85308-2719

(385) 297-1770

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 390200000X Primary	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Christopher Leigh Fullmer

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Edwards, Pamela (Pam) Ann

Haong, Samantha

Dang, Shayla Hoang My

Blacklidge, Tiffany

Nguyen, Phillip Huy

Diehl, Allison Michelle

Purewal, Karen Kaur

Shun, Justin Jay

James, Jacob Mark

Russell, Ian