Healthcare Provider Details

I. General information

NPI: 1013588300
Provider Name (Legal Business Name): HONORHEALTH AMBULATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5681 W BEVERLY LN STE 101
GLENDALE AZ
85306-9800
US

IV. Provider business mailing address

2500 W UTOPIA RD
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-0071
  • Fax:
Mailing address:
  • Phone: 480-587-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN NEIL
Title or Position: EVP/CPE
Credential:
Phone: 480-587-5123