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NPI Code Detail

MEDICARE: PHOENIX PEDIATRICS LTD

MEDICARE: PHOENIX PEDIATRICS LTD
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
1208000000XPediatrics PhysicianAZ

General Provider Information

NPI Number : 1871788513
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENIX PEDIATRICS LTD
Provider Business Mailing Address
First Line : 4434 N 12TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-4507
Country : US
Telephone Number : 602-242-5121
Fax Number : 602-242-6945
Provider Business Practice Location Address
First Line : 4434 N 12TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-4507
Country : US
Telephone Number : 602-242-5121
Fax Number :
Authorized Official
Title or Position : BILLING AND CODING COORDIATOR
Name : NANCIE ODONNELL
Credential :
Telephone Number : 602-242-5121
Provider Enumeration Date : 09/06/2007
Last Update Date : 07/21/2022

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Directions to “PHOENIX PEDIATRICS LTD ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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