Provider Demographics
NPI:1447378518
Name:CAMELBACK WOMENS HEALTH, PC
Entity Type:Organization
Organization Name:CAMELBACK WOMENS HEALTH, PC
Other - Org Name:CAMELBACK WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:FEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-494-5050
Mailing Address - Street 1:11209 N TATUM BLVD
Mailing Address - Street 2:#255
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028
Mailing Address - Country:US
Mailing Address - Phone:602-494-5050
Mailing Address - Fax:602-494-2611
Practice Address - Street 1:11209 N TATUM BLVD
Practice Address - Street 2:#255
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:602-494-5050
Practice Address - Fax:602-494-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ67303Medicare UPIN