Provider Demographics
NPI:1932316882
Name:PRODIGEE HOSPITALISTS P.C.
Entity Type:Organization
Organization Name:PRODIGEE HOSPITALISTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:VELARDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-357-2048
Mailing Address - Street 1:4711 E FALCON DR
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-2593
Mailing Address - Country:US
Mailing Address - Phone:480-357-2048
Mailing Address - Fax:480-358-9286
Practice Address - Street 1:4711 E FALCON DR
Practice Address - Street 2:SUITE 355
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2593
Practice Address - Country:US
Practice Address - Phone:480-357-2048
Practice Address - Fax:480-358-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22015208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF73111Medicare UPIN