NPIMap

Organization Active NPI

Cigna Healthcare of Arizona, Inc.

  • Clinical Medical Laboratory
  • Phoenix, AZ
National Provider Identifier
1053427880
Registry record updated Jan 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CIGNA HEALTHCARE OF ARIZONA, INC.
Practice address
8826 N 23Rd Ave
Phoenix, AZ 85021-4154
Phone
(602) 328-8400
NPI assigned
Aug 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2014

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

Authorized official

Name
Kevin Ellis, D.O.
Title
Chief Medical Director
Phone
(623) 277-2246

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

8826 N 23Rd Ave
Phoenix, AZ 85021-4154

Mailing address

25500 N Norterra Dr
Attn: HCFS
Phoenix, AZ 85085-8200
Phone (602) 328-8400

Other identifiers 1

IdentifierTypeStateIssuer
320911MedicaidAZ

Other names 1

  • Health Diagnostics Lab Doing business as

National Provider Directory

National Provider Directory

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1053427880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25500 N NORTERRA DR",
            "address_2": "ATTN: HCFS",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850858200",
            "telephone_number": "602-328-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8826 N 23RD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850214154",
            "telephone_number": "602-328-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIGNA HEALTHCARE OF ARIZONA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2014-01-28",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CHIEF MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "623-277-2246",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320911",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Diagnostics Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; 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.