Provider Demographics
NPI:1437351251
Name:B-HEALTHY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:B-HEALTHY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CHARMELE
Authorized Official - Last Name:BRINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-247-2300
Mailing Address - Street 1:9150 W INDIAN SCHOOL RD
Mailing Address - Street 2:#105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2384
Mailing Address - Country:US
Mailing Address - Phone:623-247-2300
Mailing Address - Fax:623-247-1939
Practice Address - Street 1:9150 W. INDIAN SCHOOL ROAD
Practice Address - Street 2:#105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037
Practice Address - Country:US
Practice Address - Phone:623-247-2300
Practice Address - Fax:623-247-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1972679181OtherETHAN KENNEDY
AZ1265408975OtherDAVID BICKLER
AZ1255310967OtherDEIDREJSOLBERG-DANIELSMD
AZ1972679181OtherETHAN KENNEDY