Provider Demographics
NPI:1780928135
Name:INTERION GROUP INC
Entity type:Organization
Organization Name:INTERION GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-807-2372
Mailing Address - Street 1:4202 N 32ND ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4746
Mailing Address - Country:US
Mailing Address - Phone:800-807-2372
Mailing Address - Fax:
Practice Address - Street 1:4202 N 32ND ST
Practice Address - Street 2:SUITE F
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4746
Practice Address - Country:US
Practice Address - Phone:800-807-2372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-23
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 2085R0202X
AZAS74502086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty