Provider Demographics
NPI:1205845641
Name:ARIZONA CENTER FOR CHEST DISEASES LTD
Entity type:Organization
Organization Name:ARIZONA CENTER FOR CHEST DISEASES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCOT
Authorized Official - Middle Name:S
Authorized Official - Last Name:PREMKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-264-5685
Mailing Address - Street 1:5090 N 40TH ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2111
Mailing Address - Country:US
Mailing Address - Phone:602-264-5685
Mailing Address - Fax:602-631-9870
Practice Address - Street 1:5090 N 40TH ST
Practice Address - Street 2:SUITE 122
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2111
Practice Address - Country:US
Practice Address - Phone:602-264-5685
Practice Address - Fax:602-631-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCHBNMedicare ID - Type Unspecified
AZWCHBNMedicare UPIN