Provider Demographics
NPI:1538530779
Name:ARCADIA PHYSICIANS TRAVEL CLINIC
Entity type:Organization
Organization Name:ARCADIA PHYSICIANS TRAVEL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-955-8700
Mailing Address - Street 1:4350 E CAMELBACK RD
Mailing Address - Street 2:SUITE F-100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2701
Mailing Address - Country:US
Mailing Address - Phone:602-955-8700
Mailing Address - Fax:602-325-0133
Practice Address - Street 1:4350 E CAMELBACK RD
Practice Address - Street 2:SUITE F-100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2701
Practice Address - Country:US
Practice Address - Phone:602-955-8700
Practice Address - Fax:602-325-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ47542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0861590OtherBLUE CROSS BLUE SHEILD