Healthcare Provider Details

I. General information

NPI: 1013171263
Provider Name (Legal Business Name): MARICOPA INTEGRATED HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W BROWN RD
MESA AZ
85201-3227
US

IV. Provider business mailing address

570 W BROWN RD
MESA AZ
85201-3227
US

V. Phone/Fax

Practice location:
  • Phone: 480-344-2028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number14523
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM JAMES
Title or Position: PROGRAM DIRECTOR
Credential: M.D.
Phone: 480-344-2028