1316186364 NPI number — CMG CARE TODAY - PINNACLE PEAK

Table of content: (NPI 1316186364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316186364 NPI number — CMG CARE TODAY - PINNACLE PEAK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CMG CARE TODAY - PINNACLE PEAK
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:
1316186364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25500 N NORTERRA DR
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:
85085-8200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-328-8400
Provider Business Mailing Address Fax Number:
623-277-2335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7609 E PINNACLE PEAK RD
Provider Second Line Business Practice Location Address:
SUITE C-9
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85255-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-585-0095
Provider Business Practice Location Address Fax Number:
480-585-0185
Provider Enumeration Date:
02/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BURRELL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
602-271-5426

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  OTC4578 , 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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