Provider Demographics
NPI:1295391324
Name:HIGLEY PARK INTEGRATED HEALTH GROUP LLC
Entity Type:Organization
Organization Name:HIGLEY PARK INTEGRATED HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIVONKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-892-0022
Mailing Address - Street 1:1355 S HIGLEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1355 S HIGLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4799
Practice Address - Country:US
Practice Address - Phone:480-892-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty