Provider Demographics
NPI:1235322819
Name:HOSPITAL DEVELOPMENT OF WEST PHOENIX, INC.
Entity Type:Organization
Organization Name:HOSPITAL DEVELOPMENT OF WEST PHOENIX, INC.
Other - Org Name:ABRAZO MARYVALE CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-882-1717
Mailing Address - Street 1:20 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6154
Mailing Address - Country:US
Mailing Address - Phone:615-665-6000
Mailing Address - Fax:615-665-6197
Practice Address - Street 1:5102 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1703
Practice Address - Country:US
Practice Address - Phone:623-848-5107
Practice Address - Fax:623-848-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ300676Medicaid
AZ118630Medicare PIN