Provider Demographics
NPI:1790959393
Name:ARIZONA INDEPENDENT MEDICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ARIZONA INDEPENDENT MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-556-0060
Mailing Address - Street 1:PO BOX 2277
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-2277
Mailing Address - Country:US
Mailing Address - Phone:928-556-0060
Mailing Address - Fax:928-556-0015
Practice Address - Street 1:3150 N WINDING BROOK RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0972
Practice Address - Country:US
Practice Address - Phone:928-556-0060
Practice Address - Fax:928-556-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ333425Medicaid
AZZ135964OtherPTAN
Z121954Medicare UPIN
Z121955Medicare UPIN
Z135964Medicare Oscar/Certification