Provider Demographics
NPI:1093351884
Name:PHX MYMED HEALTH ACCESS SOLUTIONS
Entity Type:Organization
Organization Name:PHX MYMED HEALTH ACCESS SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-354-1187
Mailing Address - Street 1:5777 N. POST ROAD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2007
Mailing Address - Country:US
Mailing Address - Phone:317-354-1187
Mailing Address - Fax:317-354-1369
Practice Address - Street 1:5777 N. POST ROAD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2007
Practice Address - Country:US
Practice Address - Phone:317-354-1187
Practice Address - Fax:317-354-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty