Healthcare Provider Details

I. General information

NPI: 1891895637
Provider Name (Legal Business Name): PHOENICIAN MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 N ALMA SCHOOL RD STE 160
CHANDLER AZ
85224-5941
US

IV. Provider business mailing address

1343 N ALMA SCHOOL RD STE 160
CHANDLER AZ
85224-5941
US

V. Phone/Fax

Practice location:
  • Phone: 480-963-1853
  • Fax: 480-726-0695
Mailing address:
  • Phone: 480-963-1853
  • Fax: 480-726-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateAZ

VIII. Authorized Official

Name: PARAMVIR S TULI
Title or Position: C.E.O.
Credential:
Phone: 480-776-5489