Provider Demographics
NPI:1225167703
Name:AFFINITY GYN INC.
Entity Type:Organization
Organization Name:AFFINITY GYN INC.
Other - Org Name:AFFINITY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-874-2900
Mailing Address - Street 1:6200 S MCCLINTOCK DR
Mailing Address - Street 2:#104
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3268
Mailing Address - Country:US
Mailing Address - Phone:480-388-3666
Mailing Address - Fax:480-388-3667
Practice Address - Street 1:6200 S MCCLINTOCK DR
Practice Address - Street 2:#104
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3268
Practice Address - Country:US
Practice Address - Phone:480-388-3666
Practice Address - Fax:480-388-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN082443261QA0005X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ149395OtherAHCCCS NUMBER
AZP85105Medicare UPIN