Provider Demographics
NPI:1124145842
Name:MAGELLAN HEALTH SERVICES OF ARIZONA, INC.
Entity type:Organization
Organization Name:MAGELLAN HEALTH SERVICES OF ARIZONA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ADAIR
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-797-8333
Mailing Address - Street 1:4129 E VAN BUREN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6939
Mailing Address - Country:US
Mailing Address - Phone:800-654-5465
Mailing Address - Fax:
Practice Address - Street 1:903 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1906
Practice Address - Country:US
Practice Address - Phone:602-416-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2691261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ127960Medicaid