Basic Information
| Provider Information | |||||||||
| NPI: | 1992345664 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIAN GROUP OF ARIZONA INC | ||||||||
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| OtherOrganizationName: | STEWARD ORTHOPEDIC AND SPORTS MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 N PERAL STREET | ||||||||
| Address2: | SUITE 2400 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752012470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693418800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7727 W DEER VALLEY RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853822120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025533113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2020 | ||||||||
| LastUpdateDate: | 04/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | DINSDALE | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6027977070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.