Healthcare Provider Details

I. General information

NPI: 1124251699
Provider Name (Legal Business Name): PHOENIX MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14877 W BELL RD SUITE 100
SURPRISE AZ
85374-7610
US

IV. Provider business mailing address

9145 W THUNDERBIRD RD SUITE 101
PEORIA AZ
85381-4820
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-7800
  • Fax: 623-815-7900
Mailing address:
  • Phone: 623-815-7800
  • Fax: 623-815-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT R ORR
Title or Position: PRESIDENT
Credential: DO
Phone: 623-815-7800