Provider Demographics
NPI:1598187734
Name:SONORAN HEALTH SPECIALISTS, INC
Entity Type:Organization
Organization Name:SONORAN HEALTH SPECIALISTS, INC
Other - Org Name:SONORAN HEALTH SPECIALISTS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-767-3877
Mailing Address - Street 1:8414 E SHEA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6665
Mailing Address - Country:US
Mailing Address - Phone:480-767-3877
Mailing Address - Fax:480-767-3878
Practice Address - Street 1:8414 E SHEA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6665
Practice Address - Country:US
Practice Address - Phone:480-767-3877
Practice Address - Fax:480-767-3878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SONORAN HEALTH SPECIALISTS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22415261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF14206Medicare UPIN