1790950988 NPI number — CIGNA HEALTHCARE OF ARIZONA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790950988 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 MESA HEALTH CARE CENTER, RED MOUNTAIN MEDICAL OFFICE
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:
1790950988
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:
5735 E MCKELLIPS RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85215-2875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-718-6444
Provider Business Practice Location Address Fax Number:
480-718-6443
Provider Enumeration Date:
04/28/2008

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 , with the licence number:  OTC 4262 , 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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