Provider Demographics
NPI:1467633784
Name:ARIZONA INSTITUTE OF GERIATRIC MEDICINE
Entity Type:Organization
Organization Name:ARIZONA INSTITUTE OF GERIATRIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-815-8887
Mailing Address - Street 1:PO BOX 26048
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0117
Mailing Address - Country:US
Mailing Address - Phone:623-815-8887
Mailing Address - Fax:623-815-5374
Practice Address - Street 1:10503 W THUNDERBIRD BLVD
Practice Address - Street 2:#366
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3022
Practice Address - Country:US
Practice Address - Phone:623-815-8887
Practice Address - Fax:623-815-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29375261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty