Provider Demographics
NPI:1073626883
Name:METROPOLITAN PSYCHIATRIC PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:METROPOLITAN PSYCHIATRIC PHYSICIANS, P.C.
Other - Org Name:METROPOLITAN PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:TILLOTSON
Authorized Official - Last Name:BURGOYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-862-4427
Mailing Address - Street 1:PO BOX 94448
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85070-4448
Mailing Address - Country:US
Mailing Address - Phone:480-862-4427
Mailing Address - Fax:
Practice Address - Street 1:4055 W CHANDLER BLVD
Practice Address - Street 2:STE 5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3700
Practice Address - Country:US
Practice Address - Phone:480-862-4427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCJDVMedicare ID - Type Unspecified