=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730770322
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HONORHEALTH MEDICAL GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2021
-----------------------------------------------------
Last Update Date | 01/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18801 N THOMPSON PEAK PKWY STE 110
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-6347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-471-5702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 W UTOPIA RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85027-4171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-587-5314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP
-----------------------------------------------------
Name | JOHN NEIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-587-5123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------