Healthcare Provider Details

I. General information

NPI: 1912053752
Provider Name (Legal Business Name): EMERGENCY PHYSICIANS SOUTHWEST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6644 E BAYWOOD AVE
MESA AZ
85206-1747
US

IV. Provider business mailing address

PO BOX 635623
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 480-321-2000
  • Fax: 480-321-4198
Mailing address:
  • Phone: 925-924-1600
  • Fax: 925-924-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHARON HARDY
Title or Position: DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 925-251-6901