Healthcare Provider Details

I. General information

NPI: 1215972104
Provider Name (Legal Business Name): SPECTRUM HEALTH CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4136 N 75TH AVE STE 101
PHOENIX AZ
85033-3171
US

IV. Provider business mailing address

4136 N 75TH AVE STE 101
PHOENIX AZ
85033-3171
US

V. Phone/Fax

Practice location:
  • Phone: 623-849-2220
  • Fax: 623-849-2574
Mailing address:
  • Phone: 623-849-2220
  • Fax: 623-849-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BILLY JOE EVANS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-849-2220