Basic Information
| Provider Information | |||||||||
| NPI: | 1275569501 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEONATOLOGY ASSOCIATES, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 W CLARENDON AVE | ||||||||
| Address2: | 375 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022774161 | ||||||||
| FaxNumber: | 6022743394 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W CLARENDON AVE | ||||||||
| Address2: | 375 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022774161 | ||||||||
| FaxNumber: | 6022743394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CALDWELL | ||||||||
| AuthorizedOfficialFirstName: | BETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 6022774161 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170100000X | X | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Medical Genetics, Ph.D. Medical Genetics | 170300000X | X | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Genetic Counselor, MS | 207SG0201X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | 208000000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 231H00000X | X | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 363A00000X | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363LN0000X | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
ID Information
| ID | Type | State | Issuer | Description | 005513 | 05 | AZ | MEDICAID |