1881915502 NPI number — CIGNA HEALTHCARE OF ARIZONA, INC.

Table of content: (NPI 1881915502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881915502 NPI number — CIGNA HEALTHCARE OF ARIZONA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CIGNA HEALTHCARE OF ARIZONA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CIGNA CMG CARE TODAY-SOUTH CHANDLER; SOUTH CHANDLER CARE TODAY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881915502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25500 N NORTERRA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85085-8200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-328-8400
Provider Business Mailing Address Fax Number:
623-277-2335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4980 S ALMA SCHOOL RD
Provider Second Line Business Practice Location Address:
STE. A-3
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85248-5545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-895-8955
Provider Business Practice Location Address Fax Number:
480-895-1602
Provider Enumeration Date:
06/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BURRELL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
602-271-5426

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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