Provider Demographics
NPI:1376797597
Name:ION OF PHEONIX, LLC
Entity Type:Organization
Organization Name:ION OF PHEONIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-433-1717
Mailing Address - Street 1:8129 N 87TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4399
Mailing Address - Country:US
Mailing Address - Phone:800-977-1513
Mailing Address - Fax:
Practice Address - Street 1:8129 N 87TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4399
Practice Address - Country:US
Practice Address - Phone:800-977-1513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ION HEATLHCARE CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies