Provider Demographics
NPI:1447365168
Name:PRODIGEE INPATIENT PHYSICIANS GROUP, P.L.L.C.
Entity type:Organization
Organization Name:PRODIGEE INPATIENT PHYSICIANS GROUP, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-357-2048
Mailing Address - Street 1:4711 E FALCON DR
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2593
Mailing Address - Country:US
Mailing Address - Phone:480-357-2048
Mailing Address - Fax:480-214-5147
Practice Address - Street 1:4711 E FALCON DR
Practice Address - Street 2:SUITE 355
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2593
Practice Address - Country:US
Practice Address - Phone:480-357-2048
Practice Address - Fax:480-214-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75781Medicare PIN