Provider Demographics
NPI:1669747150
Name:PHOENIX MEDICAL GROUP INC
Entity type:Organization
Organization Name:PHOENIX MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-701-1800
Mailing Address - Street 1:4355 E AIRPORT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7812
Mailing Address - Country:US
Mailing Address - Phone:818-701-1800
Mailing Address - Fax:818-885-1171
Practice Address - Street 1:4355 E AIRPORT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7812
Practice Address - Country:US
Practice Address - Phone:818-701-1800
Practice Address - Fax:818-885-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X, 207X00000X, 225100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty