PHOENIX CHILDREN'S MEDICAL GROUP NPI 1154660959

NPI Information

NPI: 1154660959
Provider Name: PHOENIX CHILDREN'S MEDICAL GROUP

Other Name: PHOENIX CHILDREN'S AMBULATORY SPECIALTY CENTER - AVONDALE

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
1665 N AVONDALE BLVD
AVONDALE, AZ
ZIP 85392
Phone: (602) 933-0005
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PHOENIX CHILDREN'S MEDICAL GROUP is a multi-specialty clinic center in Avondale, AZ. PHOENIX CHILDREN'S MEDICAL GROUP NPI is 1154660959. The provider is registered as an organization entity type.
The provider Other Name Is Phoenix Children's Ambulatory Specialty Center - Avondale.

The provider's business location address is:

1665 N AVONDALE BLVD
AVONDALE, AZ
ZIP 85392-003
Phone: (602) 933-0005
Fax: (602) 933-2478

The provider's authorized official is Raheel Farough .
The authorized official title is Svp, Managed Care & Payer Strategy and has the following contact phone number (602) 933-3548.

The enumeration date for this NPI number is 2/14/2013 and was last updated on 5/22/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty	SH3107	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	876253	MEDICAID	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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