Provider Demographics
NPI:1124054473
Name:ARIZONA INSTITUTE OF RESPIRATORY MEDICINE LLC
Entity type:Organization
Organization Name:ARIZONA INSTITUTE OF RESPIRATORY MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RUNDBAKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-975-0500
Mailing Address - Street 1:14418 W MEEKER BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5283
Mailing Address - Country:US
Mailing Address - Phone:623-975-0500
Mailing Address - Fax:623-975-0705
Practice Address - Street 1:14418 W MEEKER BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5283
Practice Address - Country:US
Practice Address - Phone:623-975-0500
Practice Address - Fax:623-975-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ79752Medicare ID - Type Unspecified