Organization
ARIZONA BLEEDING DISORDERS HEALTH AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRBY HOLLIDAY (CREDENTIALING MANAGER)
(480) 857-3900
Entity
Organization
Contact information
Practice address
821 N 5TH AVE, PHOENIX, AZ 85003-1315
(602) 680-7722
(602) 682-5135
Mailing address
821 N 5TH AVE, PHOENIX, AZ 85003-1315
(602) 680-7722
(602) 682-5135
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OTC6802
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC6802
OUTPATIENT TREATMENT CENTER LICENCE
AZ
Enumeration date
04/13/2015
Last updated
07/06/2015
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