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General NPI Number Information
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NPI Number | 1902346919
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Entity Type | Organization
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Legal Business Name | CORIZON HEALTH
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 950 W ELLIOT RD
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City | TEMPE
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State | AZ
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Zip | 85284-1144
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Country | US
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Telephone | 480-897-9515
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Fax |
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Provider Business Mailing Address
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Address Line | 950 WEST ELLIOT ROAD
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City | TEMPE
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State | AZ
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Zip | 85284
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Country | US
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Telephone | 480-897-9515
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | WINFRED WILLIAMS
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Credential | MD
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Telephone | 480-897-9515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number | AP9752
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License Number State | AZ
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