Healthcare Provider Details

I. General information

NPI: 1053427880
Provider Name (Legal Business Name): CIGNA HEALTHCARE OF ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8826 N 23RD AVE
PHOENIX AZ
85021-4154
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 602-328-8400
  • Fax:
Mailing address:
  • Phone: 602-328-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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