Provider Demographics
NPI:1023355724
Name:ARIZONA SYNERGY
Entity type:Organization
Organization Name:ARIZONA SYNERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, INTEGRATED MEDICINE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-750-5861
Mailing Address - Street 1:11801 N TATUM BLVD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1611
Mailing Address - Country:US
Mailing Address - Phone:928-750-5861
Mailing Address - Fax:
Practice Address - Street 1:2573 S ARIZONA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7336
Practice Address - Country:US
Practice Address - Phone:928-750-5861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty