NPIMap

Organization Active NPI

Identity Hormones LLC

  • Adult Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1326642372
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
IDENTITY HORMONES LLC
Doing business as
Identity Hormones LLC
Practice address
100 E Camelback Rd Ste 108
Phoenix, AZ 85012-1061
Phone
(901) 757-3643
NPI assigned
Nov 30, 2020
Last updated
Nov 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Authorized official

Name
Amanda Wilkinson
Title
Business Operations Director
Phone
(702) 818-0446

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X NU Primary
Primary Care Clinic/Center 261QP2300X NU

Addresses

Primary practice location

100 E Camelback Rd Ste 108
Phoenix, AZ 85012-1061

Mailing address

100 E Camelback Rd Ste 108
Phoenix, AZ 85012-1061

Other names 1

  • Identity Hormones LLC Doing business as

National Provider Directory

National Provider Directory

Locations

100 E Camelback Rd
Ste 108
Phoenix, AZ 85012
Phone (602) 354-3925

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1326642372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E CAMELBACK RD STE 108",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E CAMELBACK RD STE 108",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121061",
            "telephone_number": "901-757-3643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTITY HORMONES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-30",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "702-818-0446"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Identity Hormones LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Identity Hormones LLC",
            "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 Nov 11, 2024; 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.