Basic Information
| Provider Information | |||||||||
| NPI: | 1528169125 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HONORHEALTH | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HONORHEALTH DEER VALLEY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 19829 N 27TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850274001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238796100 | ||||||||
| FaxNumber: | 6238795400 | ||||||||
| Practice Location | |||||||||
| Address1: | 19829 N 27TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850274001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238796100 | ||||||||
| FaxNumber: | 6238795400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HENDRIX | ||||||||
| AuthorizedOfficialFirstName: | JENIFER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR NETWORK DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6236834503 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H0167 | AZ | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 860117301 | 01 | AZ | FEDERAL CORRECTIONAL INST | OTHER | 860117301 | 01 | AZ | CHOICE CARE NETWORK | OTHER | 860117301 | 01 | AZ | DONOR NETWORK OF AZ | OTHER | 860117301 | 01 | AZ | CITY OF GLENDALE WORKERS | OTHER | 446246 | 05 | AZ | MEDICAID | 860117301 | 01 | AZ | FIRST HEALTH | OTHER | 860117301 | 01 | AZ | COMMUNITY CARE NETWORK | OTHER | 860117301 | 01 | AZ | AZ DEPT OF JUVENILE CORR | OTHER | 860117301 | 01 | AZ | HEALTH MGMT NETWORK | OTHER | 860117301 | 01 | AZ | ACCOUNTABLE HEALTH PLANS | OTHER | 0000 | 01 | AZ | BLUE CROSS TRICARE | OTHER | AZ0204830 | 01 | AZ | BLUE CROSS AZ | OTHER | 860117301 | 01 | AZ | AZ STATE PHYS ASSOC | OTHER | 860117301 | 01 | AZ | AZ FOUNDATION FOR MED CAR | OTHER | 860117301 | 01 | AZ | BEECH STREET | OTHER | 0676381 | 01 | AZ | AETNA HEALTH INC. | OTHER |