Provider Demographics
NPI:1780137570
Name:HEALTHCARE INNOVATION FRONTIER, LLC
Entity type:Organization
Organization Name:HEALTHCARE INNOVATION FRONTIER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:COZATT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:844-648-6348
Mailing Address - Street 1:PO BOX 41638
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1638
Mailing Address - Country:US
Mailing Address - Phone:844-648-6348
Mailing Address - Fax:602-926-2696
Practice Address - Street 1:20565 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3563
Practice Address - Country:US
Practice Address - Phone:844-648-6348
Practice Address - Fax:602-926-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty