MEDICARE: HEALOGICS SPECIALTY PHYSICIANS OF ARIZONA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	207V00000X	Obstetrics & Gynecology Physician
3	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417327107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALOGICS SPECIALTY PHYSICIANS OF ARIZONA LLC

Provider Business Mailing Address
First Line	:	5220 BELFORT RD STE 130
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6018
Country	:	US
Telephone Number	:	904-446-3686
Fax Number	:	904-446-3032

Provider Business Practice Location Address
First Line	:	2460 S PARKVIEW LOOP STE 205
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-5358
Country	:	US
Telephone Number	:	928-336-2030
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PAMELA MANDEL
Credential	:
Telephone Number	:	904-446-3686

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	04/07/2026

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Directions to “HEALOGICS SPECIALTY PHYSICIANS OF ARIZONA LLC ” Practice Location

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