Provider Demographics
NPI:1043228075
Name:URBAN, GINGER K (PAC)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:K
Last Name:URBAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4757
Mailing Address - Country:US
Mailing Address - Phone:602-942-4462
Mailing Address - Fax:602-371-2002
Practice Address - Street 1:2483 S MARKET ST
Practice Address - Street 2:CMG CARETODAY
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0722
Practice Address - Country:US
Practice Address - Phone:480-857-8561
Practice Address - Fax:480-821-1328
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2470363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115430Medicaid
S74022Medicare UPIN