Healthcare Provider Details

I. General information

NPI: 1962870287
Provider Name (Legal Business Name): PWI DEVELOPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W THOMAS RD SUITE 480
PHOENIX AZ
85013-4224
US

IV. Provider business mailing address

500 W THOMAS RD SUITE 480
PHOENIX AZ
85013-4224
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-1771
  • Fax: 602-264-1661
Mailing address:
  • Phone: 602-264-1771
  • Fax: 602-264-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MICHAEL J. HERVEY II
Title or Position: OWNER
Credential: MD
Phone: 602-264-1771