Healthcare Provider Details

I. General information

NPI: 1881012144
Provider Name (Legal Business Name): ARIZONA HOSPITAL SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10238 E HAMPTON AVE 205
MESA AZ
85209-3316
US

IV. Provider business mailing address

PO BOX 830822
RICHARDSON TX
75083-0822
US

V. Phone/Fax

Practice location:
  • Phone: 480-766-9479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4446
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4446
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4446
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4446
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4446
License Number StateAZ

VIII. Authorized Official

Name: JAMAL OTULA
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-364-0181