Provider Demographics
NPI:1619591682
Name:HONORHEALTH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:HONORHEALTH MEDICAL GROUP, LLC
Other - Org Name:JOHN C. LINCOLN, LLC
Other - Org Type:Former Legal Business Name
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 STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4172
Mailing Address - Country:US
Mailing Address - Phone:480-587-5314
Mailing Address - Fax:
Practice Address - Street 1:450 E RIO SALADO PKWY
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-0803
Practice Address - Country:US
Practice Address - Phone:480-882-7380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty