Provider Demographics
NPI:1821721119
Name:PHOENIX MEDICAL COLLABORATIVE LLC
Entity Type:Organization
Organization Name:PHOENIX MEDICAL COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-999-0960
Mailing Address - Street 1:42104 N VENTURE DR STE D118
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3837
Mailing Address - Country:US
Mailing Address - Phone:623-271-8704
Mailing Address - Fax:623-552-3759
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4001
Practice Address - Country:US
Practice Address - Phone:623-505-6565
Practice Address - Fax:623-552-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty