OrganizationProfessional Natural MedicalFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address9700 N 91st St Ste A115, Scottsdale, AZ 85258-5036(480) 322-8577PECOS EnrollmentBased on the most recent information from CMS, provider Professional Natural Medical does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1407495286Provider TypeOrganizationFull NameProfessional Natural MedicalSubpartNoEnumeration Date12/27/2019Last Updated9/2/2020Contact InformationPractice LocationPractice Address9700 N 91st St Ste A115, Scottsdale, AZ 85258-5036Phone(480) 322-8577FaxUnlisted FaxMailing LocationMailing AddressNickjohnson369021@Outlook.Com, 1432 W. Birch Rd, San Tan Valley, AZ 85140Phone(480) 322-8577FaxUnlisted FaxAuthorized OfficialNameJohnson, Nick James (Physician)Phone(480) 322-8577Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID495858DescriptionMedicaidIssuerUnlistedArizona