Provider Demographics
NPI:1801822119
Name:FETAL AND WOMEN'S CENTER OF ARIZONA, LLC
Entity Type:Organization
Organization Name:FETAL AND WOMEN'S CENTER OF ARIZONA, LLC
Other - Org Name:FETAL AND WOMEN'S CENTER OF ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERKELEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-756-6000
Mailing Address - Street 1:9440 E IRONWOOD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4569
Mailing Address - Country:US
Mailing Address - Phone:480-756-6000
Mailing Address - Fax:480-467-2165
Practice Address - Street 1:9440 E IRONWOOD SQUARE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4569
Practice Address - Country:US
Practice Address - Phone:480-756-6000
Practice Address - Fax:480-467-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ29769OtherAZ PHYSICIAN LICENSE
AZ29769OtherAZ PHYSICIAN LICENSE
AZA05282Medicare UPIN