Provider Demographics
NPI:1184049322
Name:ZION MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:ZION MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:OBINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-907-7707
Mailing Address - Street 1:PO BOX 11773
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0013
Mailing Address - Country:US
Mailing Address - Phone:480-907-7707
Mailing Address - Fax:480-907-7097
Practice Address - Street 1:3800 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4499
Practice Address - Country:US
Practice Address - Phone:480-907-7707
Practice Address - Fax:480-907-7097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ905950Medicaid
AZZ167052Medicare PIN