PB Medical Group of Arizona, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

PB MEDICAL GROUP OF ARIZONA, LLC

Practice address

12816 E Turquoise Ave
Scottsdale, AZ 85259-5300

Phone

(480) 840-2588

Fax

(480) 773-7340

NPI assigned

Jul 27, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marina Freeman

Title

Edi/Credentialing Specialist

Phone

(615) 567-7256

Specialties & licenses 1

Addresses

Tax ID family

PB Medical Group of Arizona LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• PB Medical Group of Arizona, LLC

  • Substance Abuse Rehabilitation Facility
  • Phoenix, AZ
  • NPI 1780155077
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566259200000",
    "number": "1043797467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207801",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207801",
            "telephone_number": "847-329-4100",
            "fax_number": "847-329-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12816 E TURQUOISE AVE",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852595300",
            "telephone_number": "480-840-2588",
            "fax_number": "480-773-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PB MEDICAL GROUP OF ARIZONA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-27",
        "last_updated": "2019-08-20",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "EDI/CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "615-567-7256"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.