Basic Information
| Provider Information | |||||||||
| NPI: | 1962420208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHCARE MANAGEMENT GROUP, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20875 N PIMA RD PMB 206 | ||||||||
| Address2: | #C-4 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852559194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059211234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15468 N. CIVIC CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | SUPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235842917 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIMMONS | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | NEIL | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5059211234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., MPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 29610 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.