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General NPI Number Information
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NPI Number | 1750450987
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Entity Type | Organization
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Legal Business Name | CIGNA HEALTH CARE OF ARIZONA INC.
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 2483 S MARKET ST SUITE 103
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City | GILBERT
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State | AZ
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Zip | 85297-6306
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Country | US
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Telephone | 480-857-8561
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Fax | 480-821-1328
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Provider Business Mailing Address
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Address Line | 11001 N BLACK CANYON HWY
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City | PHOENIX
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State | AZ
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Zip | 85029-4757
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Country | US
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Telephone | 602-861-8210
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | JAMES H. BURRELL III
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Credential | M.D.
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Telephone | 602-271-5426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OTC 4132
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License Number State | AZ
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