Healthcare Provider Details

I. General information

NPI: 1265544191
Provider Name (Legal Business Name): CIGNA HEALTH CARE OF ARIZONA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N 3RD ST
PHOENIX AZ
85012-3031
US

IV. Provider business mailing address

8888 E RAINTREE DR FL 3
SCOTTSDALE AZ
85260-3951
US

V. Phone/Fax

Practice location:
  • Phone: 602-282-9800
  • Fax:
Mailing address:
  • Phone: 602-328-8400
  • 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: KEVIN ELLIS
Title or Position: CHIEF MEDIAL DIRECTOR
Credential: D.O.
Phone: 623-277-2246