Provider Demographics
NPI:1023429164
Name:PHOENIX FEDERAL CORRECTIONAL INSTITUTE
Entity type:Organization
Organization Name:PHOENIX FEDERAL CORRECTIONAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-465-9757
Mailing Address - Street 1:37900 N 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-7008
Mailing Address - Country:US
Mailing Address - Phone:623-465-9757
Mailing Address - Fax:623-465-5116
Practice Address - Street 1:37900 N 45TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-7008
Practice Address - Country:US
Practice Address - Phone:623-465-9757
Practice Address - Fax:623-465-5116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service