Provider Demographics
NPI:1619998705
Name:ARIZONA GRAND MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:ARIZONA GRAND MEDICAL CENTER PLLC
Other - Org Name:DEWEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SATWANT
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOWRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-934-5600
Mailing Address - Street 1:PO BOX 47729
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-7729
Mailing Address - Country:US
Mailing Address - Phone:623-934-5600
Mailing Address - Fax:623-934-5603
Practice Address - Street 1:3777 CROSSINGS DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7121
Practice Address - Country:US
Practice Address - Phone:623-934-5600
Practice Address - Fax:623-934-5603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA GRAND MEDICAL CENTER PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCK3166OtherRAIL ROAD MEDICARE
AZ23904Medicare ID - Type Unspecified