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Michael Keene Demack

  • Male

Medical Specialty

Professional ID

  • NPI: 1043347313
  • PECOS ID: 9739457631
  • Enrollment ID: I20170619000691
  • Credential(MD, DO, DPM):
  • Medical School:
  • Medical School Graduation Year: 1999

Hospital Service

  • Hospital CCN1: 030033
  • Business Name (LBN)1: Banner Payson Medical Center

Medical Practices

  • Organization Name: Ponderosa Family Care, Llc
  • Group Practice ID assigned by PECOS: 1456548015
  • Number of Group Practice member: 3

Location

  • Address1: 806 S Ponderosa St
  • Address2:
  • City: Payson
  • State: Arizona
  • Zip Code: 85541
  • Phone Number: (928)468-8603

Medicare

  • Medicare Assignment: Yes
  • Report Quality of Care to Physician Quality Reporting System (PQRS):
  • Used Electronic health record (EHR):