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NPI Code Detail

MEDICARE: MAGELLAN HEALTH SERVICES OF ARIZONA, INC.

MEDICARE: MAGELLAN HEALTH SERVICES OF ARIZONA, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QU0200XUrgent Care Clinic/CenterBH2691AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124145842
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGELLAN HEALTH SERVICES OF ARIZONA, INC.
Provider Business Mailing Address
First Line : 4129 E VAN BUREN ST
Second Line : SUITE 150
City : PHOENIX
State : AZ
Zip : 85008-6939
Country : US
Telephone Number : 800-654-5465
Fax Number :
Provider Business Practice Location Address
First Line : 903 N 2ND ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-1906
Country : US
Telephone Number : 602-416-7600
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. CHRIS ADAIR CARSON
Credential : M.D.
Telephone Number : 602-797-8333
Provider Enumeration Date : 03/26/2007
Last Update Date : 09/20/2007

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