Basic Information
| Provider Information | |||||||||
| NPI: | 1245251305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANASAZI INTERNAL MEDICINE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3815 E BELL RD | ||||||||
| Address2: | SUITE 4100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024945040 | ||||||||
| FaxNumber: | 6024944020 | ||||||||
| Practice Location | |||||||||
| Address1: | 3815 E BELL RD | ||||||||
| Address2: | SUITE 4100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024945040 | ||||||||
| FaxNumber: | 6024944020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 02/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | EDELSTEIN | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | BENJAMIN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6024945040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CH7341 | 01 | AZ | RAILROAD MEDICARE | OTHER |