Provider Demographics
NPI:1265727796
Name:APOGEE MEDICAL GROUP, MISSISSIPPI, INC
Entity type:Organization
Organization Name:APOGEE MEDICAL GROUP, MISSISSIPPI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODENOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-778-3645
Mailing Address - Street 1:PO BOX 708878
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8878
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:2525 E CAMELBACK RD
Practice Address - Street 2:STE 1100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4219
Practice Address - Country:US
Practice Address - Phone:602-778-3600
Practice Address - Fax:602-778-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty