1861571093 NPI number — CIGNA HEALTH CARE 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 1861571093 NPI number — CIGNA HEALTH CARE OF ARIZONA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CIGNA HEALTH CARE 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:
CMG CARE TODAY; CMG CARE TODAY-AVONDALE
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:
1861571093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2011
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:
602-942-4462
Provider Business Mailing Address Fax Number:
623-277-2335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1473 N DYSART RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85323-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-925-4931
Provider Business Practice Location Address Fax Number:
623-882-0839
Provider Enumeration Date:
11/06/2006

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:  OTC 4101 , 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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