Provider Demographics
NPI:1992178982
Name:CAREMORE HEALTH PLAN OF ARIZONA INC
Entity Type:Organization
Organization Name:CAREMORE HEALTH PLAN OF ARIZONA INC
Other - Org Name:CAREMORE IRVINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTITIONER MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEDPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-977-4639
Mailing Address - Street 1:2930 E CAMELBACK ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016
Mailing Address - Country:US
Mailing Address - Phone:602-341-6904
Mailing Address - Fax:
Practice Address - Street 1:315 W IRVINGTON RD
Practice Address - Street 2:STE.101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-3151
Practice Address - Country:US
Practice Address - Phone:520-294-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302R00000X
AZ29936332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155518OtherPK