MEDICARE: CIGNA HEALTHCARE OF ARIZONA, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	OTC4577	AZ

General Provider Information

NPI Number	:	1750535506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIGNA HEALTHCARE OF ARIZONA, INC.

Provider Business Mailing Address
First Line	:	25500 N NORTERRA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-8200
Country	:	US
Telephone Number	:	602-328-8400
Fax Number	:	623-277-2335

Provider Business Practice Location Address
First Line	:	13794 W WADDELL RD
Second Line	:	SUITE 207
City	:	SURPRISE
State	:	AZ
Zip	:	85379-8499
Country	:	US
Telephone Number	:	623-214-8755
Fax Number	:	623-214-8664

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	JAMES H. BURRELL III
Credential	:	M.D.
Telephone Number	:	602-271-5426

Provider Enumeration Date	:	11/06/2008
Last Update Date	:	01/09/2012

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