Provider Demographics
NPI:1346269594
Name:OBSTETRIX MEDICAL GROUP OF PHOENIX PC
Entity Type:Organization
Organization Name:OBSTETRIX MEDICAL GROUP OF PHOENIX PC
Other - Org Name:ARIZONA PEDIATRIC CARDIOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-384-0175
Mailing Address - Street 1:1301 CONCORD TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2843
Mailing Address - Country:US
Mailing Address - Phone:954-384-0175
Mailing Address - Fax:954-851-1948
Practice Address - Street 1:1920 E CAMBRIDGE AVE
Practice Address - Street 2:STE 301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1459
Practice Address - Country:US
Practice Address - Phone:602-253-6000
Practice Address - Fax:602-256-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ471136Medicaid
AZZ28126Medicare PIN
AZZ80922Medicare PIN
AZZ101032Medicare PIN
AZ471136Medicaid
AZZ66957Medicare PIN