Provider Demographics
NPI:1518235381
Name:HONORHEALTH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:HONORHEALTH MEDICAL GROUP, LLC
Other - Org Name:JOHN C. LINCOLN, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-696-4020
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:480-587-5314
Mailing Address - Fax:
Practice Address - Street 1:3648 W ANTHEM WAY
Practice Address - Street 2:A-100
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-7001
Practice Address - Country:US
Practice Address - Phone:623-434-4444
Practice Address - Fax:623-434-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty