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General NPI Number Information
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NPI Number | 1336942366
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Entity Type | Organization
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Legal Business Name | GEODE HEALTH OF ARIZONA, P.C.
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 890 W ELLIOT RD STE 116
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City | GILBERT
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State | AZ
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Zip | 85233-5127
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Country | US
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Telephone | 480-674-6414
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Fax | 833-438-9917
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Provider Business Mailing Address
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Address Line | 1211 W 22ND ST STE 406
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City | OAK BROOK
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State | IL
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Zip | 60523-2169
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Country | US
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Telephone | 888-902-1704
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | BRANDY MARRINER
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Credential |
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Telephone | 630-912-4241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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