Provider Demographics
NPI:1508096975
Name:CIGNA HEALTHCARE OF ARIZONA
Entity Type:Organization
Organization Name:CIGNA HEALTHCARE OF ARIZONA
Other - Org Name:CIGNA CMG CARE TODAY - LAVEEN VILLAGE, CMG CARE TODAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:602-271-5426
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:602-328-8400
Mailing Address - Fax:623-277-2335
Practice Address - Street 1:3535 W SOUTHERN AVE
Practice Address - Street 2:SUITE # 128
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4224
Practice Address - Country:US
Practice Address - Phone:602-276-5563
Practice Address - Fax:602-276-5536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4709261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center