Provider Demographics
NPI:1760203855
Name:EXCEPTIONAL PHYSICIAN GROUP ELOY HOSPITAL PLLC
Entity type:Organization
Organization Name:EXCEPTIONAL PHYSICIAN GROUP ELOY HOSPITAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-740-9335
Mailing Address - Street 1:3514 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4901
Mailing Address - Country:US
Mailing Address - Phone:972-740-9335
Mailing Address - Fax:469-807-1208
Practice Address - Street 1:340 E MILLIGAN RD
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85131
Practice Address - Country:US
Practice Address - Phone:469-341-7800
Practice Address - Fax:469-871-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty