Provider Demographics
NPI:1295876258
Name:CHANDLER MEDICAL CENTER INC
Entity type:Organization
Organization Name:CHANDLER MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-963-4129
Mailing Address - Street 1:594 N ARIZONA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5054
Mailing Address - Country:US
Mailing Address - Phone:480-963-4129
Mailing Address - Fax:480-963-4022
Practice Address - Street 1:594 N ARIZONA AVE
Practice Address - Street 2:SUITE1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5054
Practice Address - Country:US
Practice Address - Phone:480-963-4129
Practice Address - Fax:480-963-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32864208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZM97623Medicare UPIN