Healthcare Provider Details

I. General information

NPI: 1861571093
Provider Name (Legal Business Name): CIGNA HEALTH CARE OF ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 N DYSART RD SUITE 100
AVONDALE AZ
85323-1548
US

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 623-925-4931
  • Fax: 623-882-0839
Mailing address:
  • Phone: 602-942-4462
  • Fax: 623-277-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberOTC 4101
License Number StateAZ

VIII. Authorized Official

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