Healthcare Provider Details

I. General information

NPI: 1316961022
Provider Name (Legal Business Name): OBSTETRIX MEDICAL GROUP OF ARIZONA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD STE 150
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

4722 N 24TH ST STE. 150
PHOENIX AZ
85016-4800
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-8188
  • Fax: 520-325-0809
Mailing address:
  • Phone: 602-256-4628
  • Fax: 855-851-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH S. MEREDITH
Title or Position: DIRECTOR / PRESIDENT
Credential: MD
Phone: 602-256-4628