Basic Information
| Provider Information | |||||||||
| NPI: | 1265073662 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HONORHEALTH MEDICAL GROUP, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JOHN C. LINCOLN, LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 W UTOPIA RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850274172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805875314 | ||||||||
| FaxNumber: | 4808825874 | ||||||||
| Practice Location | |||||||||
| Address1: | 9250 N 3RD ST STE 2015 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850202404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027860030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2019 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | PETRIDES | ||||||||
| AuthorizedOfficialFirstName: | SAVAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4806964020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.