Healthcare Provider Details

I. General information

NPI: 1013327881
Provider Name (Legal Business Name): ARIZONA GENERAL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 S 51ST AVE
LAVEEN AZ
85339-2923
US

IV. Provider business mailing address

PO BOX 841365
DALLAS TX
75284-1365
US

V. Phone/Fax

Practice location:
  • Phone: 972-899-6650
  • Fax: 972-899-5954
Mailing address:
  • Phone: 972-899-6650
  • Fax: 972-899-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: TIM FIELDING
Title or Position: CFO
Credential:
Phone: 972-899-6650