Provider Demographics
NPI:1710279658
Name:PHOENIX MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:PHOENIX MEDICAL GROUP, PC
Other - Org Name:PM SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-815-7800
Mailing Address - Street 1:9145 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4820
Mailing Address - Country:US
Mailing Address - Phone:623-815-7800
Mailing Address - Fax:623-815-7900
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:BLDG E
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3722
Practice Address - Country:US
Practice Address - Phone:623-815-7800
Practice Address - Fax:623-815-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22354Medicare PIN