Provider Demographics
NPI:1083594642
Name:ARIZONA PHYSICIANS GROUP
Entity type:Organization
Organization Name:ARIZONA PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA
Authorized Official - Prefix:
Authorized Official - First Name:CHARISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-476-8900
Mailing Address - Street 1:16872 E AVENUE OF THE FOUNTAINS STE 203
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-8314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16872 E AVENUE OF THE FOUNTAINS STE 203
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8314
Practice Address - Country:US
Practice Address - Phone:800-715-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA PHYSICIANS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH10326OtherLICENSE