Provider Demographics
NPI:1245251305
Name:ANASAZI INTERNAL MEDICINE, P.C.
Entity type:Organization
Organization Name:ANASAZI INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:EDELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-494-5040
Mailing Address - Street 1:3815 E BELL RD
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2122
Mailing Address - Country:US
Mailing Address - Phone:602-494-5040
Mailing Address - Fax:602-494-4020
Practice Address - Street 1:3815 E BELL RD
Practice Address - Street 2:SUITE 4100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2122
Practice Address - Country:US
Practice Address - Phone:602-494-5040
Practice Address - Fax:602-494-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCH7341OtherRAILROAD MEDICARE
AZCH7341OtherRAILROAD MEDICARE