Healthcare Provider Details

I. General information

NPI: 1750450987
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: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2483 S MARKET ST SUITE 103
GILBERT AZ
85297-6306
US

IV. Provider business mailing address

11001 N BLACK CANYON HWY
PHOENIX AZ
85029-4757
US

V. Phone/Fax

Practice location:
  • Phone: 480-857-8561
  • Fax: 480-821-1328
Mailing address:
  • Phone: 602-861-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberOTC 4132
License Number StateAZ

VIII. Authorized Official

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