Basic Information
| Provider Information | |||||||||
| NPI: | 1912979964 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VHS OUTPATIENT CLINICS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ABRAZO MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18892 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884027256 | ||||||||
| FaxNumber: | 8889021099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 N LITCHFIELD RD STE 125 | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853951215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232421231 | ||||||||
| FaxNumber: | 6232421232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | RASMUS | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP, CFO TPR | ||||||||
| AuthorizedOfficialTelephone: | 4698932532 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.