Provider Demographics
NPI: | 1619469699 |
---|---|
Name: | HONORHEALTH MEDICAL GROUP, LLC |
Entity Type: | Organization |
Organization Name: | HONORHEALTH MEDICAL GROUP, LLC |
Other - Org Name: | HONORHEALTH SPECIALTY CARE |
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: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85027-4171 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-696-4020 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6220 W BELL RD STE 130 |
Practice Address - Street 2: | |
Practice Address - City: | GLENDALE |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85308-3896 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-547-7348 |
Practice Address - Fax: | 480-882-5895 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-06-05 |
Last Update Date: | 2020-10-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty |