Healthcare Provider Details

I. General information

NPI: 1508096975
Provider Name (Legal Business Name): CIGNA HEALTHCARE OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W SOUTHERN AVE SUITE # 128
PHOENIX AZ
85041-4224
US

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 602-276-5563
  • Fax: 602-276-5536
Mailing address:
  • Phone: 602-328-8400
  • Fax: 623-277-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberOTC4709
License Number StateAZ

VIII. Authorized Official

Name: JAMES H. BURRELL III
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 602-271-5426