Healthcare Provider Details

I. General information

NPI: 1689418436
Provider Name (Legal Business Name): ARIZONA INTERVENTIONAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9425 W BELL RD
SUN CITY AZ
85351-1300
US

IV. Provider business mailing address

9425 W BELL RD
SUN CITY AZ
85351-1300
US

V. Phone/Fax

Practice location:
  • Phone: 623-399-6880
  • Fax: 623-322-1504
Mailing address:
  • Phone: 623-399-6880
  • Fax: 623-322-1504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTON BERTELSEN
Title or Position: PROJECT MANAGER
Credential:
Phone: 623-399-6880