Basic Information
| Provider Information | |||||||||
| NPI: | 1578198453 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARMONY PHYSICIAN GROUP AN ARIZONA NONPROFIT CORPORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HARMONY MEDICAL CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 964 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852990964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803664489 | ||||||||
| FaxNumber: | 4808543618 | ||||||||
| Practice Location | |||||||||
| Address1: | 81 W GUADALUPE RD STE 112 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852333321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806643840 | ||||||||
| FaxNumber: | 6026353683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2020 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | FABER | ||||||||
| AuthorizedOfficialFirstName: | JEREMIAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4803664489 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.