Provider Demographics
NPI:1205525839
Name:PHOENIX HEALTH PRACTITIONERS LLC
Entity type:Organization
Organization Name:PHOENIX HEALTH PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEHEMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-450-5020
Mailing Address - Street 1:12474 W FOREST PLEASANT PL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5666
Mailing Address - Country:US
Mailing Address - Phone:602-795-9223
Mailing Address - Fax:602-795-9728
Practice Address - Street 1:4222 N 12TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-6024
Practice Address - Country:US
Practice Address - Phone:602-795-9223
Practice Address - Fax:602-795-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty