1174091698 NPI number — PHYSICIAN GROUP OF ARIZONA INC

Table of content: (NPI 1174091698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174091698 NPI number — PHYSICIAN GROUP OF ARIZONA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN GROUP 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:
Provider Other Organization Name Type Code:
6
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:
1174091698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 281201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-1201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-243-7104
Provider Business Mailing Address Fax Number:
314-432-9683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 E VAN BUREN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85006-3742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-251-8100
Provider Business Practice Location Address Fax Number:
602-251-8685
Provider Enumeration Date:
11/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DINSDALE
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
602-797-7070

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com