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General NPI Number Information
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NPI Number | 1194609420
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Entity Type | Organization
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Legal Business Name | PHYSICIAN PAY GROUP LLC
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 9002 N CENTRAL AVE
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City | PHOENIX
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State | AZ
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Zip | 85020-2405
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Country | US
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Telephone | 480-321-6627
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Fax |
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Provider Business Mailing Address
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Address Line | 4241 N 23RD AVE APT 3
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City | PHOENIX
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State | AZ
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Zip | 85015-7006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALI-ANDRA OTTUN
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Credential |
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Telephone | 480-321-6627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 364SP0810X
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Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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