Provider Demographics
NPI:1558901215
Name:PHYSICIAN GROUP OF ARIZONA INC
Entity Type:Organization
Organization Name:PHYSICIAN GROUP OF ARIZONA INC
Other - Org Name:STEWARD ORTHOPEDIC AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DINSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-797-7070
Mailing Address - Street 1:1900 N PEARL STREET
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2470
Mailing Address - Country:US
Mailing Address - Phone:469-341-8800
Mailing Address - Fax:
Practice Address - Street 1:2122 E HIGHLAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4744
Practice Address - Country:US
Practice Address - Phone:602-553-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty