Provider Demographics
NPI:1184762890
Name:PENTZ HEALTH SERVICES LLC
Entity type:Organization
Organization Name:PENTZ HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-833-0302
Mailing Address - Street 1:6402 E SUPERSTITION SPRINGS BLVD STE 123
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4391
Mailing Address - Country:US
Mailing Address - Phone:480-833-0302
Mailing Address - Fax:480-494-5770
Practice Address - Street 1:6402 E SUPERSTITION SPRINGS BLVD STE 123
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4391
Practice Address - Country:US
Practice Address - Phone:480-833-0302
Practice Address - Fax:480-494-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6001111N00000X
AZ5115363A00000X
AZAP4770363L00000X
AZ8169111N00000X
AZ8671111N00000X
AZ6903225100000X
AZ5900111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104714Medicare ID - Type UnspecifiedGROUP NUMBER