Provider Demographics
NPI:1649417817
Name:T-BIRD FAMILY & INDUSTRIAL PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:T-BIRD FAMILY & INDUSTRIAL PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEGI
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-866-0961
Mailing Address - Street 1:14045 N. 7TH ST.
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4387
Mailing Address - Country:US
Mailing Address - Phone:602-866-0961
Mailing Address - Fax:602-866-9820
Practice Address - Street 1:14045 N 7TH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4388
Practice Address - Country:US
Practice Address - Phone:602-866-0961
Practice Address - Fax:602-866-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD47133Medicare UPIN