Provider Demographics
NPI:1265536270
Name:CIGNA HEALTHCARE OF ARIZONA, INC.
Entity type:Organization
Organization Name:CIGNA HEALTHCARE OF ARIZONA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:602-271-5426
Mailing Address - Street 1:25500 N NORTERRA DR
Mailing Address - Street 2:ATTN HCFS SUPPORT CENTER
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:623-277-1000
Mailing Address - Fax:
Practice Address - Street 1:755 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2506
Practice Address - Country:US
Practice Address - Phone:602-271-3020
Practice Address - Fax:602-271-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC 0012261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ631730Medicaid
AZ631730Medicaid
AZZWCKHLMedicare PIN