Healthcare Provider Details

I. General information

NPI: 1346811643
Provider Name (Legal Business Name): HONORHEALTH AMBULATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 100
PHOENIX AZ
85050-4204
US

IV. Provider business mailing address

2500 W UTOPIA RD
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 480-222-7246
  • Fax:
Mailing address:
  • Phone: 480-587-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN NEIL
Title or Position: SVP/CPE
Credential:
Phone: 480-587-5123