Healthcare Provider Details

I. General information

NPI: 1043090236
Provider Name (Legal Business Name): PHOENICIAN MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 W NORTHERN AVE STE B202
PHOENIX AZ
85021-9351
US

IV. Provider business mailing address

1343 N ALMA SCHOOL RD STE 160
CHANDLER AZ
85224-5901
US

V. Phone/Fax

Practice location:
  • Phone: 480-963-1853
  • Fax:
Mailing address:
  • Phone: 480-963-1853
  • Fax: 480-963-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANUPAM AHLAWAT
Title or Position: COO
Credential:
Phone: 480-444-7447