# PRIVIA MEDICAL GROUP ARIZONA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760441141
- **Authorized official:** MICHAEL MCHORNEY (CFO)
- **Authorized official phone:** (602) 633-3838

## Contact information

- **Practice address:** 3815 E BELL RD STE 4500, PHOENIX, AZ 85032-2171
- **Practice address phone:** (602) 633-3838
- **Practice address fax:** (602) 633-3838
- **Mailing address:** 3815 E BELL RD STE 4500, PHOENIX, AZ 85032-2171
- **Mailing address phone:** (602) 633-3838
- **Mailing address fax:** (602) 633-3841

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207VG0400X | Gynecology Physician | — | NULL | — |
| 207VG0400X | Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 2085R0001X | Radiation Oncology Physician | — | NULL | — |
| 2085R0001X | Radiation Oncology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |

## Other

- **Enumeration date:** 03/22/2006
- **Last updated:** 05/02/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 326831 | — | AZ |