Basic Information
| Provider Information | |||||||||
| NPI: | 1730152174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUMBERLAND | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CUMBERLAND | ||||||||
| OtherFirstName: | PATTI | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 18701 N 67TH AVE | ||||||||
| Address2: | ARROWHEAD EMERGENCY DEPARTMENT | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853087100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235617222 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2000 W BETHANY HOME RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850152443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022490212 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 32350 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 860373636 | 01 | AZ | HUMANA GROUP NBR | OTHER | AZ0728670 | 01 | AZ | BLUECROSS BLUESHIELD GRP | OTHER | 871071 | 05 | AZ | MEDICAID | 453051001 | 01 | AZ | GROUPHEALTH GROUP NUMBER | OTHER | AW1436 | 01 | AZ | HEALTHNET GROUP NUMBER | OTHER | 3981220 | 01 | AZ | EVERCARE GROUP NUMBER | OTHER |