MEDICARE: SPECTRUM HEALTHCARE GROUP, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker
4	163WP0808X	Psychiatric/Mental Health Registered Nurse
5	171M00000X	Case Manager/Care Coordinator
6	207Q00000X	Family Medicine Physician
7	207R00000X	Internal Medicine Physician
8	208000000X	Pediatrics Physician
9	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
10	2084P0800X	Psychiatry Physician
11	208VP0000X	Pain Medicine Physician
12	363A00000X	Physician Assistant
13	363L00000X	Nurse Practitioner
14	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
15	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1912614413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HEALTHCARE GROUP, INC

Provider Business Mailing Address
First Line	:	8 E COTTONWOOD ST
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-4382
Country	:	US
Telephone Number	:	877-634-7333
Fax Number	:	866-984-3891

Provider Business Practice Location Address
First Line	:	11024 N 28TH DR STE 110A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4378
Country	:	US
Telephone Number	:	877-634-7333
Fax Number	:	866-984-3891

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	CORINNE BAILEY
Credential	:
Telephone Number	:	877-634-7333

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	06/11/2025

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