1932560729 NPI number — HEALTH GROUP PROVIDERS, LLC

Table of content: (NPI 1932560729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932560729 NPI number — HEALTH GROUP PROVIDERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH GROUP PROVIDERS, LLC
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:
VIRTUHEALTH
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:
1932560729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 E RIVULON BLVD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85297-0008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-734-5664
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 N PRIEST DRIVE
Provider Second Line Business Practice Location Address:
109
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85288-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-589-4871
Provider Business Practice Location Address Fax Number:
702-589-4872
Provider Enumeration Date:
03/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMSON
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SUPERVISOR
Authorized Official Telephone Number:
707-349-6919

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 143931 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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