Providence of Arizona, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

BH-2200 Issued in AZ

Legal business name

PROVIDENCE OF ARIZONA, INC.

Practice address

3602 W Thomas Rd
Phoenix, AZ 85019-4442

Phone

(602) 455-4626

Fax

(602) 455-4624

NPI assigned

Sep 22, 2006

Organization subpart

No

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

Authorized official

Name

Mr. David Hedgcock, M.ED

Title

Executive Director

Phone

(602) 455-4626

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Providencia Other name

Locations

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1588764427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 N CRAYCROFT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857111448",
            "telephone_number": "520-747-6676",
            "fax_number": "520-747-6605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3602 W THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850194442",
            "telephone_number": "602-455-4626",
            "fax_number": "602-455-4624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE OF ARIZONA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEDGCOCK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "602-455-4626",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.ED"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AZ",
            "license": "BH-2200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "796021",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providencia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Proudly Arizona LLC
• Providence General Medicine
• Providence General Medicine, PC
• Providence Health Group LLC (Genesis Wellness & Pain Management Center)
• Providence Hospice and Palliative Care Inc
• Providence Pediatrics
• Providential Western Medical
• Province Anesthesia LLC
• Abby Catherine Prow
• Proxy Medical Group PC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.