1760718621 NPI number — CIGNA HEALTHCARE OF ARIZONA, INC.

Table of content: (NPI 1760693808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760718621 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:
EVERNORTH CARE GROUP PALLM VALLEY HEALTH CENTER
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:
1760718621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8888 E RAINTREE DR FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-3951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-328-8400
Provider Business Mailing Address Fax Number:
623-277-1091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13481 W MCDOWELL RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOODYEAR
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85395-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-536-3720
Provider Business Practice Location Address Fax Number:
623-536-3730
Provider Enumeration Date:
10/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHEIF MEDICAL DIRECTOR
Authorized Official Telephone Number:
623-277-2246

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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