Provider Demographics
NPI:1649426073
Name:WELLCARE HEALTH INSURANCE OF ARIZONA, INC.
Entity type:Organization
Organization Name:WELLCARE HEALTH INSURANCE OF ARIZONA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-206-1490
Mailing Address - Street 1:8735 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1143
Mailing Address - Country:US
Mailing Address - Phone:813-290-6200
Mailing Address - Fax:813-290-6210
Practice Address - Street 1:949 KAMOKILA BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-675-7300
Practice Address - Fax:813-283-9343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLCARE HEALTH PLANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization