Healthcare Provider Details

I. General information

NPI: 1942371505
Provider Name (Legal Business Name): CIGNA HEALTH CARE OF ARIZONA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 E BASELINE RD STE 107
GILBERT AZ
85234-2726
US

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 480-632-4060
  • Fax:
Mailing address:
  • Phone: 602-328-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberOTC 3167
License Number StateAZ

VIII. Authorized Official

Name: KEVIN ELLIS
Title or Position: CHIEF MEDICAL DIRECTOR
Credential: D.O
Phone: 623-277-2246