Healthcare Provider Details

I. General information

NPI: 1265536270
Provider Name (Legal Business Name): CIGNA HEALTHCARE OF ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MCDOWELL RD
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

25500 N NORTERRA DR ATTN HCFS SUPPORT CENTER
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 602-271-3020
  • Fax: 602-271-5394
Mailing address:
  • Phone: 623-277-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC 0012
License Number StateAZ

VIII. Authorized Official

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