Provider Demographics
NPI:1992378012
Name:STAGEZERO PHYSICIAN HOLDINGS INC
Entity Type:Organization
Organization Name:STAGEZERO PHYSICIAN HOLDINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAHRRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-762-0666
Mailing Address - Street 1:8751 PARK CENTRAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1162
Mailing Address - Country:US
Mailing Address - Phone:804-762-0666
Mailing Address - Fax:
Practice Address - Street 1:8825 N 23RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4148
Practice Address - Country:US
Practice Address - Phone:804-762-0666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZNAOtherINSURANCE AGENCIES