Provider Demographics
NPI:1871788513
Name:PHOENIX PEDIATRICS LTD
Entity type:Organization
Organization Name:PHOENIX PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CODING COORDIATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-242-5121
Mailing Address - Street 1:4434 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4507
Mailing Address - Country:US
Mailing Address - Phone:602-242-5121
Mailing Address - Fax:602-242-6945
Practice Address - Street 1:4434 N 12TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4507
Practice Address - Country:US
Practice Address - Phone:602-242-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ961955Medicare PIN
AZG23801Medicare UPIN
AZ892431Medicare PIN
AZA35278Medicare UPIN
AZG98355Medicare UPIN
AZH10780Medicare UPIN
AZC99565Medicare UPIN
AZ34009Medicare UPIN