Healthcare Provider Details

I. General information

NPI: 1073691093
Provider Name (Legal Business Name): HONORHEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE SUITE 308
PHOENIX AZ
85027-4013
US

IV. Provider business mailing address

2500 W UTOPIA RD
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 623-780-1999
  • Fax: 623-516-0950
Mailing address:
  • Phone: 480-587-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberOTC3148
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOTC 2379
License Number StateAZ

VIII. Authorized Official

Name: SAVAS PETRIDES
Title or Position: SVP/CEO
Credential:
Phone: 480-696-4020