Provider Demographics
NPI:1740269299
Name:IRONWOOD PHYSICIANS, PC
Entity type:Organization
Organization Name:IRONWOOD PHYSICIANS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PARVINDERJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHANUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-821-2838
Mailing Address - Street 1:PO BOX 29901
Mailing Address - Street 2:DEPT 991
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-0901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:695 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5665
Practice Address - Country:US
Practice Address - Phone:480-821-2838
Practice Address - Fax:480-821-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCK2502OtherRAILROAD MEDICARE
AZ512808OtherAHCCCS
AZCK2502OtherRAILROAD MEDICARE