MEDICARE: CENTRAL PHOENIX OB GYN

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
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z148730	OTHER	AZ	PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902187354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL PHOENIX OB GYN

Provider Business Mailing Address
First Line	:	2034 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1403
Country	:	US
Telephone Number	:	602-288-0777
Fax Number	:	602-340-0398

Provider Business Practice Location Address
First Line	:	2034 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1403
Country	:	US
Telephone Number	:	602-288-0777
Fax Number	:	602-340-0398

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHARON R THOMPSON
Credential	:	MD
Telephone Number	:	602-288-0777

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	07/29/2013

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