Healthcare Provider Details

I. General information

NPI: 1164970968
Provider Name (Legal Business Name): NHC ARIZONA PROFESSIONAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15571 N REEMS RD
SURPRISE AZ
85374-9584
US

IV. Provider business mailing address

15571 N REEMS RD
SURPRISE AZ
85374-9584
US

V. Phone/Fax

Practice location:
  • Phone: 623-544-6932
  • Fax: 623-321-1070
Mailing address:
  • Phone: 623-544-6932
  • Fax: 623-321-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: VANESSA BATTAGLIA
Title or Position: CONTRACTS ADMINISTRATOR
Credential:
Phone: 281-306-0369