MEDICARE: MAGELLAN HEALTH SERVICES 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	251B00000X	Case Management Agency	BH2980	AZ

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	:	1962526251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGELLAN HEALTH SERVICES OF ARIZONA, INC.

Provider Business Mailing Address
First Line	:	4129 EAST VAN BUREN STREET
Second Line	:	SUITE 150
City	:	PHOENIX
State	:	AZ
Zip	:	85008
Country	:	US
Telephone Number	:	800-645-5465
Fax Number	:

Provider Business Practice Location Address
First Line	:	14040 N CAVE CREEK RD
Second Line	:	#110
City	:	PHOENIX
State	:	AZ
Zip	:	85022-6117
Country	:	US
Telephone Number	:	602-992-9336
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. CHRIS ADAIR CARSON
Credential	:	MD
Telephone Number	:	602-797-8333

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	10/15/2007

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