Healthcare Provider Details

I. General information

NPI: 1902462179
Provider Name (Legal Business Name): PHYSICIAN GROUP OF ARIZONA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E WASHINGTON ST STE 200
PHOENIX AZ
85034-2019
US

IV. Provider business mailing address

PO BOX 24573
BELFAST ME
04915-4496
US

V. Phone/Fax

Practice location:
  • Phone: 602-507-4500
  • Fax: 602-688-8311
Mailing address:
  • Phone: 855-660-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DINSDALE
Title or Position: EXECUTIVE DIRECTOR, OPERATIONS
Credential:
Phone: 602-797-7070