Provider Demographics
NPI:1033104716
Name:HONORHEALTH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:HONORHEALTH MEDICAL GROUP, LLC
Other - Org Name:JOHN C. LINCOLN LLC DBA ARCADIA FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-696-4020
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:480-587-5314
Mailing Address - Fax:
Practice Address - Street 1:4131 N 24TH ST
Practice Address - Street 2:SUITE B-102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6262
Practice Address - Country:US
Practice Address - Phone:602-955-6632
Practice Address - Fax:602-381-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ25032Medicare PIN