Healthcare Provider Details

I. General information

NPI: 1225162324
Provider Name (Legal Business Name): MAGELLAN HEALTH SERVICES OF ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 S ALMA SCHOOL RD
MESA AZ
85210-3064
US

IV. Provider business mailing address

4129 EAST VAN BUREN STREET SUITE 150
PHOENIX AZ
85008
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-3846
  • Fax:
Mailing address:
  • Phone: 800-654-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberBH2967
License Number StateAZ

VIII. Authorized Official

Name: DR. CHRIS ADAIR CARSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 602-797-8333