Provider Demographics
NPI:1003178229
Name:MARICOPA INTEGRATED HEALTH SYSTEM
Entity Type:Organization
Organization Name:MARICOPA INTEGRATED HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEHENTBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:PMP
Authorized Official - Phone:602-344-8435
Mailing Address - Street 1:5110 N 32ND ST
Mailing Address - Street 2:312
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1451
Mailing Address - Country:US
Mailing Address - Phone:310-801-8491
Mailing Address - Fax:
Practice Address - Street 1:2601 E ROOSEVELT ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4973
Practice Address - Country:US
Practice Address - Phone:602-344-5366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN038285282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital