Provider Demographics
NPI:1336339258
Name:ARIZONA DEPARTMENT OF CORRECTIONS
Entity Type:Organization
Organization Name:ARIZONA DEPARTMENT OF CORRECTIONS
Other - Org Name:ADC HEALTH SERVICES BUREAU
Other - Org Type:Other Name
Authorized Official - Title/Position:BUREAU ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-364-2900
Mailing Address - Street 1:1601 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-3002
Mailing Address - Country:US
Mailing Address - Phone:602-364-2900
Mailing Address - Fax:602-364-2958
Practice Address - Street 1:2500 E VAN BUREN ST
Practice Address - Street 2:ASPC PHOENIX HEALTH UNIT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6037
Practice Address - Country:US
Practice Address - Phone:602-685-3100
Practice Address - Fax:602-685-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty