Provider Demographics
NPI:1073846879
Name:ARIZONA GASTROENTEROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ARIZONA GASTROENTEROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEIRSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:877-283-4714
Mailing Address - Street 1:5529 E ANGELA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5873
Mailing Address - Country:US
Mailing Address - Phone:877-283-4714
Mailing Address - Fax:623-444-5495
Practice Address - Street 1:5529 E ANGELA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5873
Practice Address - Country:US
Practice Address - Phone:877-283-4714
Practice Address - Fax:623-444-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35693207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ755267Medicaid
H76520Medicare UPIN