Provider Demographics
NPI:1134155724
Name:TBIRD HOSPITALIST GROUP, LLC
Entity type:Organization
Organization Name:TBIRD HOSPITALIST GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAYASHREE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-548-9700
Mailing Address - Street 1:5757 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE E-155
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4641
Mailing Address - Country:US
Mailing Address - Phone:602-548-9700
Mailing Address - Fax:602-948-9709
Practice Address - Street 1:5757 W THUNDERBIRD RD
Practice Address - Street 2:SUITE E-155
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4641
Practice Address - Country:US
Practice Address - Phone:602-548-9700
Practice Address - Fax:602-948-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ83756Medicare ID - Type Unspecified