Provider Demographics
NPI:1760718621
Name:CIGNA HEALTHCARE OF ARIZONA, INC.
Entity Type:Organization
Organization Name:CIGNA HEALTHCARE OF ARIZONA, INC.
Other - Org Name:EVERNORTH CARE GROUP PALLM VALLEY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-277-2246
Mailing Address - Street 1:8888 E RAINTREE DR FL 3
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3951
Mailing Address - Country:US
Mailing Address - Phone:602-328-8400
Mailing Address - Fax:623-277-1091
Practice Address - Street 1:13481 W MCDOWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2720
Practice Address - Country:US
Practice Address - Phone:623-536-3720
Practice Address - Fax:623-536-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center