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NPI Code Detail

MEDICARE: CIGNA HEALTH CARE OF ARIZONA INC.

MEDICARE: CIGNA HEALTH CARE 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
1261Q00000XClinic/CenterOTC 0643AZ

Other Identifiers

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

General Provider Information

NPI Number : 1770654105
Entity Type Code : Organization
Provider Name (Legal Business Name) : CIGNA HEALTH CARE 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 :
Provider Business Practice Location Address
First Line : 16635 N 43RD AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85053-2707
Country : US
Telephone Number : 602-843-7900
Fax Number :
Authorized Official
Title or Position : CHIEF MEDICAL DIRECTOR
Name : KEVIN ELLIS
Credential : D.O
Telephone Number : 623-277-2246
Provider Enumeration Date : 11/09/2006
Last Update Date : 02/06/2014

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