Provider Demographics
NPI:1891895637
Name:PHOENICIAN MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:PHOENICIAN MEDICAL CENTER, INC
Other - Org Name:PHOENICIAN PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:PARAMVIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:TULI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-776-5489
Mailing Address - Street 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5941
Mailing Address - Country:US
Mailing Address - Phone:480-963-1853
Mailing Address - Fax:480-726-0695
Practice Address - Street 1:1343 N ALMA SCHOOL RD
Practice Address - Street 2:STE 160
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5941
Practice Address - Country:US
Practice Address - Phone:480-963-1853
Practice Address - Fax:480-726-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207Q00000X, 213E00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ29968Medicare PIN