Provider Demographics
NPI:1427224443
Name:ARIZONA GRAND MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:ARIZONA GRAND MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOWRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-550-4065
Mailing Address - Street 1:PO BOX 47729
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-7729
Mailing Address - Country:US
Mailing Address - Phone:602-550-4065
Mailing Address - Fax:623-934-5603
Practice Address - Street 1:7900 E FLORENTINE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2218
Practice Address - Country:US
Practice Address - Phone:928-632-1155
Practice Address - Fax:928-632-8295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty