Healthcare Provider Details

I. General information

NPI: 1336339258
Provider Name (Legal Business Name): ARIZONA DEPARTMENT OF CORRECTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E VAN BUREN ST ASPC PHOENIX HEALTH UNIT
PHOENIX AZ
85008-6037
US

IV. Provider business mailing address

1601 W JEFFERSON ST
PHOENIX AZ
85007-3002
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-3100
  • Fax: 602-685-3111
Mailing address:
  • Phone: 602-364-2900
  • Fax: 602-364-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. DENNIS KENDALL
Title or Position: BUREAU ADMINISTRATOR
Credential: PHD
Phone: 602-364-2900