Healthcare Provider Details

I. General information

NPI: 1023113271
Provider Name (Legal Business Name): CIGNA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

25500 N NORTERRA DR
PHOENIX AZ
85085-8200
US

V. Phone/Fax

Practice location:
  • Phone: 602-942-4462
  • Fax: 623-277-1091
Mailing address:
  • Phone: 602-942-4462
  • Fax: 623-277-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN ELLIS
Title or Position: CHIEF MEDICAL DIRECTOR
Credential: DO
Phone: 623-277-2246