Provider Demographics
NPI:1174091698
Name:PHYSICIAN GROUP OF ARIZONA INC
Entity type:Organization
Organization Name:PHYSICIAN GROUP OF ARIZONA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DINSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-797-7070
Mailing Address - Street 1:PO BOX 281201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1201
Mailing Address - Country:US
Mailing Address - Phone:866-243-7104
Mailing Address - Fax:314-432-9683
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:602-251-8100
Practice Address - Fax:602-251-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty