Provider Demographics
NPI:1083164867
Name:PHOENIX CHILDREN'S CARE NETWORK
Entity Type:Organization
Organization Name:PHOENIX CHILDREN'S CARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-933-7226
Mailing Address - Street 1:3200 E CAMELBACK RD
Mailing Address - Street 2:STE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2311
Mailing Address - Country:US
Mailing Address - Phone:602-933-7226
Mailing Address - Fax:602-933-7227
Practice Address - Street 1:3200 E CAMELBACK RD
Practice Address - Street 2:STE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2311
Practice Address - Country:US
Practice Address - Phone:602-933-7226
Practice Address - Fax:602-933-7227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization