Basic Information
| Provider Information | |||||||||
| NPI: | 1053800250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVON HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12409 W INDIAN SCHOOL RD STE B210 | ||||||||
| Address2: | |||||||||
| City: | AVONDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853929505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239359920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12409 W INDIAN SCHOOL RD STE B210 | ||||||||
| Address2: | |||||||||
| City: | AVONDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853929505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239359920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2018 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | MORGAN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6239359920 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.