1033389911 NPI number — GYNECOLGY CENTER OF PHOENIX

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 1033389911 NPI number — GYNECOLGY CENTER OF PHOENIX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GYNECOLGY CENTER OF PHOENIX
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:
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:
1033389911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 E HIGHLAND AVE STE 225A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-4885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-234-1700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 E HIGHLAND AVE STE 225A
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:
85016-4885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-234-1700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OBADIA
Authorized Official First Name:
JACK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-234-1700

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  2692 , 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)