Provider Demographics
NPI:1861584583
Name:ARROWHEAD PEDIATRICS
Entity type:Organization
Organization Name:ARROWHEAD PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:STONECIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-537-2501
Mailing Address - Street 1:18700 N 64TH DR
Mailing Address - Street 2:STE 301
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7109
Mailing Address - Country:US
Mailing Address - Phone:623-561-5437
Mailing Address - Fax:623-561-2316
Practice Address - Street 1:18700 N 64TH DR
Practice Address - Street 2:STE 301
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7109
Practice Address - Country:US
Practice Address - Phone:623-561-5437
Practice Address - Fax:623-561-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2440208000000X
AZ33404208000000X
AZ30213208000000X
AZ2208363A00000X
AZ3229363A00000X
AZ4394208000000X
AZ3489363A00000X
AZ36022208000000X
AZ3326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ008625Medicaid