Basic Information
| Provider Information | |||||||||
| NPI: | 1861584583 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARROWHEAD PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18700 N 64TH DR | ||||||||
| Address2: | STE 301 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853087109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235615437 | ||||||||
| FaxNumber: | 6235612316 | ||||||||
| Practice Location | |||||||||
| Address1: | 18700 N 64TH DR | ||||||||
| Address2: | STE 301 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853087109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235615437 | ||||||||
| FaxNumber: | 6235612316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STONECIPHER | ||||||||
| AuthorizedOfficialFirstName: | ANDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6235372501 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2440 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 33404 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 30213 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 363A00000X | 2208 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 3229 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 208000000X | 4394 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 363A00000X | 3489 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 208000000X | 36022 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 363A00000X | 3326 | AZ | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 008625 | 05 | AZ | MEDICAID |