# DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PHOENIX INDIAN MEDICAL CENTER
- **Other names:** PIMC Professsional Services
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1184738049
- **Legal business name:** PHOENIX INDIAN MEDICAL CENTER
- **Authorized official:** DR. LAURA A TILLMAN MD (CMO)
- **Authorized official phone:** (602) 263-1674

## Contact information

- **Practice address:** 4212 N 16TH ST, PHOENIX, AZ 85016-5319
- **Practice address phone:** (602) 263-1200
- **Practice address fax:** (602) 263-1618
- **Mailing address:** PO BOX 95460, CLEVELAND, OH 44193-0698
- **Mailing address phone:** (602) 581-6088
- **Mailing address fax:** (602) 263-1619

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207K00000X | Allergy & Immunology Physician | — | NULL | — |
| 207K00000X | Allergy & Immunology Physician | — | — | — |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | — |
| 207W00000X | Ophthalmology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 207ZP0101X | Anatomic Pathology Physician | — | NULL | — |
| 207ZP0101X | Anatomic Pathology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 08/18/2006
- **Last updated:** 05/26/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 022062 | — | AZ |
| 05 | — | 092354 | — | AZ |
| 05 | — | 418196 | — | AZ |
| 01 | — | P206550 | BCBSAZ | AZ |