Provider Demographics
NPI:1821415902
Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Other - Org Name:MARICOPA INTEGRATED HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-344-2830
Mailing Address - Street 1:PO BOX 29670
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9670
Mailing Address - Country:US
Mailing Address - Phone:602-344-8178
Mailing Address - Fax:
Practice Address - Street 1:8088 W WHITNEY DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6564
Practice Address - Country:US
Practice Address - Phone:833-855-9973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH3673261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ987495Medicaid
AZAZ0947OtherHEALTHNET OF AZ
AZ29517OtherPHOENIX INDIAN MEDICAL CENTER
AZ500005OtherEVERCARE CHOICE
AZ631935OtherAETNA
AZAZ0205850OtherBLUE CROSS BLUE SHIELD
AZ189350800OtherUD DEPT OF LABOR
AZ189350800OtherUD DEPT OF LABOR