Provider Demographics
NPI:1538593157
Name:ARIZONA DEPARTMENT OF HEALTH SERVICES
Entity type:Organization
Organization Name:ARIZONA DEPARTMENT OF HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-364-0679
Mailing Address - Street 1:150 N 18TH AVENUE, SUITE 320
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-3205
Mailing Address - Country:US
Mailing Address - Phone:602-542-1866
Mailing Address - Fax:602-364-1494
Practice Address - Street 1:150 N 18TH AVENUE, SUITE 320
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3205
Practice Address - Country:US
Practice Address - Phone:602-542-1866
Practice Address - Fax:602-364-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ703886Medicaid