Provider Demographics
NPI:1548253529
Name:ARIZONA PEDIATRIC HEMATOLOGY
Entity type:Organization
Organization Name:ARIZONA PEDIATRIC HEMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-512-3214
Mailing Address - Street 1:1432 S DOBSON RD
Mailing Address - Street 2:STE 107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4768
Mailing Address - Country:US
Mailing Address - Phone:480-833-1123
Mailing Address - Fax:480-833-1124
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:STE 107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:480-833-1123
Practice Address - Fax:480-833-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68649Medicare ID - Type UnspecifiedGROUP #