Healthcare Provider Details

I. General information

NPI: 1679738835
Provider Name (Legal Business Name): ARIZONA EM-I MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19829 N 27TH AVE
PHOENIX AZ
85027-4001
US

IV. Provider business mailing address

PO BOX 7427
PHILADELPHIA PA
19101-7427
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-6316
  • Fax:
Mailing address:
  • Phone: 805-563-3011
  • Fax: 805-564-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD T GODBOLD
Title or Position: PRESIDENT
Credential: MD
Phone: 805-563-3011