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General NPI Number Information
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NPI Number | 1043797467
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Entity Type | Organization
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Legal Business Name | PB MEDICAL GROUP OF ARIZONA, LLC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 12816 E TURQUOISE AVE
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5300
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Country | US
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Telephone | 480-840-2588
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Fax | 480-773-7340
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Provider Business Mailing Address
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Address Line | PO BOX 207801
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City | DALLAS
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State | TX
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Zip | 75320-7801
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Country | US
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Telephone | 847-329-4100
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Fax | 847-329-4900
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Authorized Official
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Title or Position | EDI/CREDENTIALING SPECIALIST
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Name | MARINA FREEMAN
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Credential |
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Telephone | 615-567-7256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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