NPIMap

Organization Active NPI

Arizona Bleeding Disorders Health and Wellness Center

  • General Practice Physician
  • Phoenix, AZ
National Provider Identifier
1982090338
Registry record updated Jul 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
OTC6802 Issued in AZ
Legal business name
ARIZONA BLEEDING DISORDERS HEALTH AND WELLNESS CENTER
Practice address
821 N 5TH Ave
Phoenix, AZ 85003-1315
Phone
(602) 680-7722
Fax
(602) 682-5135
NPI assigned
Apr 13, 2015
Last updated
Jul 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2015

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

Authorized official

Name
Kirby Holliday
Title
Credentialing Manager
Phone
(480) 857-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X OTC6802 AZ Primary

Addresses

Primary practice location

821 N 5TH Ave
Phoenix, AZ 85003-1315

Mailing address

821 N 5TH Ave
Phoenix, AZ 85003-1315
Phone (602) 680-7722

Other identifiers 1

IdentifierTypeStateIssuer
OTC6802OtherAZOUTPATIENT TREATMENT CENTER LICENCE

National Provider Directory

National Provider Directory

Locations

821 N 5th Ave
Phoenix, AZ 85003
Phone (602) 680-7722

NPI Registry JSON

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

{
    "created_epoch": "1428883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436140800000",
    "number": "1982090338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 N 5TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850031315",
            "telephone_number": "602-680-7722",
            "fax_number": "602-682-5135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 N 5TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850031315",
            "telephone_number": "602-680-7722",
            "fax_number": "602-682-5135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA BLEEDING DISORDERS HEALTH AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-13",
        "last_updated": "2015-07-06",
        "status": "A",
        "authorized_official_last_name": "HOLLIDAY",
        "authorized_official_first_name": "KIRBY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "480-857-3900"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "AZ",
            "license": "OTC6802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OUTPATIENT TREATMENT CENTER LICENCE",
            "identifier": "OTC6802",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 6, 2015; 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.