Provider Demographics
NPI:1902462179
Name:PHYSICIAN GROUP OF ARIZONA INC
Entity Type:Organization
Organization Name:PHYSICIAN GROUP OF ARIZONA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, 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 24573
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4496
Mailing Address - Country:US
Mailing Address - Phone:855-660-0300
Mailing Address - Fax:
Practice Address - Street 1:4801 E WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2019
Practice Address - Country:US
Practice Address - Phone:602-507-4500
Practice Address - Fax:602-688-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty