Provider Demographics
NPI:1326196858
Name:FOUNTAIN HILLS PEDIATRICS AND INTERNAL MEDICINE PLC
Entity Type:Organization
Organization Name:FOUNTAIN HILLS PEDIATRICS AND INTERNAL MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-837-6800
Mailing Address - Street 1:PO BOX 20019
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85269-0019
Mailing Address - Country:US
Mailing Address - Phone:480-837-6800
Mailing Address - Fax:480-837-6804
Practice Address - Street 1:13620 N SAGUARO BLVD
Practice Address - Street 2:STE 50
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8551
Practice Address - Country:US
Practice Address - Phone:480-837-6800
Practice Address - Fax:480-837-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ825995Medicaid
AZAZ0740661OtherBCBSAZ
AZZ113581Medicare PIN