Provider Demographics
NPI:1003270596
Name:CIGNA MEDICAL GROUP
Entity Type:Organization
Organization Name:CIGNA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-277-1130
Mailing Address - Street 1:8888 E RAINTREE DR FL 3
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3951
Mailing Address - Country:US
Mailing Address - Phone:602-328-8400
Mailing Address - Fax:
Practice Address - Street 1:3003 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3031
Practice Address - Country:US
Practice Address - Phone:602-282-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIGNA HEALTHCARE OF ARIZONA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-11
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8558363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty