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General NPI Number Information
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NPI Number | 1740459700
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Entity Type | Organization
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Legal Business Name | PRIVIA MEDICAL GROUP ARIZONA, LLC
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 111 W CEDAR LN STE A
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City | PAYSON
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State | AZ
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Zip | 85541-5417
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Country | US
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Telephone | 602-633-3780
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Fax | 602-633-3782
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Provider Business Mailing Address
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Address Line | 3815 E BELL RD STE 4500
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City | PHOENIX
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State | AZ
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Zip | 85032-2171
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Country | US
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Telephone | 602-633-3838
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Fax | 602-633-3850
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL MCHORNEY
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Credential |
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Telephone | 602-633-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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