Provider Demographics
NPI:1073576740
Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Other - Org Name:VALLEYWISE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-344-2830
Mailing Address - Street 1:PO BOX 29670
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9670
Mailing Address - Country:US
Mailing Address - Phone:602-344-8152
Mailing Address - Fax:602-344-8136
Practice Address - Street 1:2601 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008
Practice Address - Country:US
Practice Address - Phone:602-344-8152
Practice Address - Fax:602-344-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3680261QE0700X
261QH0100X
AZH3673273R00000X, 282N00000X
AZBHH745283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No273R00000XHospital UnitsPsychiatric Unit
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007212Medicaid
AZ1203013OtherVALUE OPTIONS
AZ500005OtherEVERCARE CHOICE
AZF00968OtherPHOENIX HEALTH PLAN
AZAZ0947OtherHEALTHNET OF AZ
AZ020107Medicaid
AZ030022AOtherSECTION 1011
AZ126434OtherBCCF KOMEN GRANT
AZ29517OtherPHOENIX INDIAN MED CENTER
AZ189350800OtherUS DEPT OF LABOR
AZ1203013OtherVALUE OPTIONS BLOCK
AZAZ0205850OtherBLUE CROSS BLUE SHIELD
AZ631935OtherAETNA
AZ007212Medicaid
AZF00968OtherPHOENIX HEALTH PLAN
AZ030022AOtherSECTION 1011
AZ007212Medicaid
AZ29517OtherPHOENIX INDIAN MED CENTER
AZ03S022Medicare Oscar/Certification