=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033256037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHOENIX FAMILY MEDICINE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 04/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2040 W BETHANY HOME RD SUITE #102
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85015-2445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-995-4400
-----------------------------------------------------
Fax | 602-995-4401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2040 W BETHANY HOME RD SUITE #102
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85015-2445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-995-4400
-----------------------------------------------------
Fax | 602-995-4401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY PHYSICIAN
-----------------------------------------------------
Name | GARO HARMANIAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 602-995-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3867
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------