Jack R Hannallah (NPI# 1497018915, PAC ID# 3274898481) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DIAGNOSTIC RADIOLOGY.
| Nation Provider ID (NPI) | 1497018915 |
| PAC ID by PECOS | 3274898481 |
| Professional Enrollment ID | I20181025001409 |
| Full Name | Jack R Hannallah |
| Organization Legal Name | MODERN VASCULAR OF MESA, LLC |
| Address |
535 E Mckellips Rd Bldg S Mesa AZ 85203-2522 |
| Phone Number | 8189492632 |
| Gender | M |
| Medical School | UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE |
| Graduation Year | 2012 |
| Primary Specialty | DIAGNOSTIC RADIOLOGY |
| Secondary Specialties | INTERVENTIONAL RADIOLOGY |
| Group Practice PAC ID | 0446537948 |
| Number of Group Practice Members | 12 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 030064 | BANNER - UNIVERSITY MEDICAL CENTER TUCSON CAMPUS |
| Address | Phone | Organization |
|---|---|---|
| 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 | 8189492632 | MODERN VASCULAR OF MESA, LLC |
| 1501 N Campbell Ave, Rm 3401, Tucson, AZ 85724-0001 | 5206265437 | BANNER UNIVERSITY MEDICAL GROUP |
| 2171 W Orange Grove Rd, Tucson, AZ 85741-3118 | 5202014980 | MODERN VASCULAR OF TUCSON LLC |
| 2800 E Ajo Way, Suite 100 105, Tucson, AZ 85713-6204 | 5208742000 | BANNER UNIVERSITY MEDICAL GROUP |
| Organization Legal Name | MODERN VASCULAR OF MESA, LLC |
| Physicians | 10 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Scott M Brannan | Diagnostic Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Nikhil C Patel | Interventional Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Dalton Emil Ishmail | Physician Assistant | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Kristi Ford | Nurse Practitioner | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Cordell A Esplin | Interventional Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Ana Garcia | Nurse Practitioner | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Brian W Zernich | Diagnostic Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Jacqueline M Walker | Nurse Practitioner | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Arthur Thomas Maydell | Diagnostic Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Street Address |
535 E MCKELLIPS RD BLDG S |
| City | MESA |
| State | AZ |
| Zip | 85203-2522 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Scott M Brannan | Diagnostic Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Nikhil C Patel | Interventional Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Dalton Emil Ishmail | Physician Assistant | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Kristi Ford | Nurse Practitioner | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Cordell A Esplin | Interventional Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Betsy L Zeh | Physician Assistant | Modern Vascular Institute, LLC | 535 E Mckellips Rd, Suite 111, Mesa, AZ 85203-2525 |
| Ana Garcia | Nurse Practitioner | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Brian W Zernich | Diagnostic Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Jacqueline M Walker | Nurse Practitioner | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Shannon Brown | Physician Assistant | Nextcare Arizona LLC | 535 E Mckellips Rd, Suite 101, Mesa, AZ 85203-2525 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Diana L Kesler-laclair | Nurse Practitioner | Alta Dermatology Group Ltd | 130 S 63rd St Bldg 3, Suite 114, Mesa, AZ 85203-1620 |
| Stephen Emerson Kessler | Dermatology | Alta Dermatology Group Ltd | 130 S 63rd St Bldg 3, Suite 114, Mesa, AZ 85203-1620 |
| Justin T Sawyer | Dermatology | Alta Dermatology Group Ltd | 130 S 63rd St Bldg 3, Suite 114, Mesa, AZ 85203-1620 |
| Megan G Davidson | Dermatology | Alta Dermatology Group Ltd | 130 S 63rd St Bldg 3, Suite 114, Mesa, AZ 85203-1620 |
| Arthur Thomas Maydell | Diagnostic Radiology | Modern Vascular of Mesa, LLC | 535 E Mckellips Rd, Bldg S, Mesa, AZ 85203-2522 |
| Brinly J Crooks | Physician Assistant | Nextcare Arizona LLC | 535 E Mckellips Rd, Suite 101, Mesa, AZ 85203-2525 |
| Jennifer A Capizzi Garand | Physician Assistant | Nextcare Arizona LLC | 535 E Mckellips Rd, Suite 101, Mesa, AZ 85203-2525 |
| Donald Byron Beeler | Nurse Practitioner | The Little Clinic of Arizona LLC | 1935 N Stapley Dr, Mesa, AZ 85203-2749 |
| Tammy L Cakmak | Nurse Practitioner | The Little Clinic of Arizona LLC | 1935 N Stapley Dr, Mesa, AZ 85203-2749 |
| Jolynn J Briles | Nurse Practitioner | The Little Clinic of Arizona LLC | 1935 N Stapley Dr, Mesa, AZ 85203-2749 |
| Find all physicians in zip 85203 | |||
| City | MESA |
| Zip Code | 85203 |
| Specialty | DIAGNOSTIC RADIOLOGY |
| City + Specialty | MESA + DIAGNOSTIC RADIOLOGY |
Please comment or provide details below to improve the information on Jack R Hannallah.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.