Organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM.
Active
Parent organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Other names
PIMC DME's
Organization subpart
Yes
Provider details
NPI number
Legal business name
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Authorized official
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 44101-0033
(602) 581-6088
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022062
—
AZ
05
—
092354
—
AZ
05
—
418196
—
AZ
01
—
P0206550
BCBSAZ
AZ
Enumeration date
08/17/2006
Last updated
05/26/2021
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