Provider Demographics
NPI:1205378171
Name:AGH LAVEEN LLC
Entity Type:Organization
Organization Name:AGH LAVEEN LLC
Other - Org Name:DIGNITY HEALTH ARIZONA GENERAL HOSPITAL EMERGENCY ROOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-410-4523
Mailing Address - Street 1:3030 N CENTRAL AVE STE 1402
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2720
Mailing Address - Country:US
Mailing Address - Phone:602-406-3306
Mailing Address - Fax:
Practice Address - Street 1:2977 E GERMANN RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1586
Practice Address - Country:US
Practice Address - Phone:480-732-7540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH6937261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
030136Medicare Oscar/Certification