Healthcare Provider Details

I. General information

NPI: 1538593157
Provider Name (Legal Business Name): ARIZONA DEPARTMENT OF HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N 18TH AVENUE, SUITE 320
PHOENIX AZ
85007-3205
US

IV. Provider business mailing address

150 N 18TH AVENUE, SUITE 320
PHOENIX AZ
85007-3205
US

V. Phone/Fax

Practice location:
  • Phone: 602-542-1866
  • Fax: 602-364-1494
Mailing address:
  • Phone: 602-542-1866
  • Fax: 602-364-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES H HUMBLE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 602-364-0679