Healthcare Provider Details

I. General information

NPI: 1003270596
Provider Name (Legal Business Name): CIGNA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N 3RD ST
PHOENIX AZ
85012-3031
US

IV. Provider business mailing address

8888 E RAINTREE DR FL 3
SCOTTSDALE AZ
85260-3951
US

V. Phone/Fax

Practice location:
  • Phone: 602-282-9800
  • Fax:
Mailing address:
  • Phone: 602-328-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP8558
License Number StateAZ

VIII. Authorized Official

Name: YOLANDA RENEE GREEN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 623-277-1130