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General NPI Number Information
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NPI Number | 1679703441
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Entity Type | Organization
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Legal Business Name | PHOENIX CHILDREN'S MEDICAL GROUP
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 20325 N 51ST AVE STE 116
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City | GLENDALE
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State | AZ
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Zip | 85308-5674
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Country | US
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Telephone | 602-933-0003
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Fax | 602-933-6152
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Provider Business Mailing Address
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Address Line | 2108 E THOMAS RD STE 130
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City | PHOENIX
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State | AZ
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Zip | 85016-0008
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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 | SVP, MANAGED CARE & PAYOR STRATEGY
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Name | RAHEEL FAROUGH
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Credential |
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Telephone | 602-933-3548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | SH3107
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License Number State | AZ
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