Organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM.
Active
Parent organization
PHOENIX INDIAN MEDICAL CENTER
Other names
PIMC Professsional Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHOENIX INDIAN MEDICAL CENTER
Authorized official
DR. LAURA A TILLMAN MD (CMO)
(602) 263-1674
Entity
Organization
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 263-1618
Mailing address
PO BOX 95460, CLEVELAND, OH 44193-0698
(602) 581-6088
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207L00000X
Anesthesiology Physician
—
—
207N00000X
Dermatology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207ZP0101X
Anatomic Pathology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022062
—
AZ
05
—
092354
—
AZ
05
—
418196
—
AZ
01
—
P206550
BCBSAZ
AZ
Enumeration date
08/18/2006
Last updated
05/26/2021
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