Provider Demographics
NPI:1619351210
Name:HENRY L GIVRE MD FCCP PC
Entity Type:Organization
Organization Name:HENRY L GIVRE MD FCCP PC
Other - Org Name:HENRY L GIVRE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-836-8701
Mailing Address - Street 1:1780 E FLORENCE BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4782
Mailing Address - Country:US
Mailing Address - Phone:520-836-8701
Mailing Address - Fax:520-836-1993
Practice Address - Street 1:1780 E FLORENCE BLVD
Practice Address - Street 2:STE 110
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4782
Practice Address - Country:US
Practice Address - Phone:520-836-8701
Practice Address - Fax:520-836-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13200207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ232223Medicaid
AZ232223Medicaid
AZMD13200Medicare PIN