Provider Demographics
NPI:1083851448
Name:HONORHEALTH AMBULATORY
Entity Type:Organization
Organization Name:HONORHEALTH AMBULATORY
Other - Org Name:SCOTTSDALE HEALTHCARE CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SVP/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-696-4020
Mailing Address - Street 1:2500 W UTOPIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4172
Mailing Address - Country:US
Mailing Address - Phone:480-696-4020
Mailing Address - Fax:
Practice Address - Street 1:7351 E OSBORN RD
Practice Address - Street 2:SUITE 200B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6451
Practice Address - Country:US
Practice Address - Phone:480-882-5730
Practice Address - Fax:480-882-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ401674Medicaid
AZ401674Medicaid