Healthcare Provider Details

I. General information

NPI: 1750831145
Provider Name (Legal Business Name): AGH LAVEEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 E GERMANN RD
GILBERT AZ
85297-0205
US

IV. Provider business mailing address

3030 N CENTRAL AVE STE 1402
PHOENIX AZ
85012-2720
US

V. Phone/Fax

Practice location:
  • Phone: 480-494-5000
  • Fax:
Mailing address:
  • Phone: 602-406-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberH6937
License Number StateAZ

VIII. Authorized Official

Name: JANE HANSON
Title or Position: CEO
Credential:
Phone: 480-410-4523