Provider Demographics
NPI:1548016223
Name:CAMELBACK PULMONARY AND CRITICAL CARE, PLLC
Entity type:Organization
Organization Name:CAMELBACK PULMONARY AND CRITICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRIGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORONENKO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:602-999-6268
Mailing Address - Street 1:4641 N 39TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3612
Mailing Address - Country:US
Mailing Address - Phone:602-999-6268
Mailing Address - Fax:
Practice Address - Street 1:1111 E MCDOWELL RD FL 11
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-999-6268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty