1992055396 NPI number — ARROWHEAD FAMILY HEALTH CENTER PC

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 1992055396 NPI number — ARROWHEAD FAMILY HEALTH CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARROWHEAD FAMILY HEALTH CENTER PC
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:
1992055396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16390 N 59TH AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85306-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-334-4000
Provider Business Mailing Address Fax Number:
623-334-4400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17061 N AVENUE OF THE ARTS
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85378-6995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-334-4000
Provider Business Practice Location Address Fax Number:
623-334-4400
Provider Enumeration Date:
09/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WELLS
Authorized Official First Name:
JANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
623-334-4000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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