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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up