Provider Demographics
NPI:1336434083
Name:ARROWHEAD FAMILY HEALTH CENTER PC
Entity Type:Organization
Organization Name:ARROWHEAD FAMILY HEALTH CENTER PC
Other - Org Name:ARROWHEAD HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-334-4000
Mailing Address - Street 1:16222 N 59TH AVE
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1701
Mailing Address - Country:US
Mailing Address - Phone:623-334-4000
Mailing Address - Fax:623-334-4400
Practice Address - Street 1:5845 E STILL CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3635
Practice Address - Country:US
Practice Address - Phone:623-334-4000
Practice Address - Fax:623-334-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5907930002Medicare NSC