Provider Demographics
NPI:1124299334
Name:DISTRICT MEDICAL GROUP INC
Entity type:Organization
Organization Name:DISTRICT MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-470-5000
Mailing Address - Street 1:2929 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8034
Mailing Address - Country:US
Mailing Address - Phone:602-470-5000
Mailing Address - Fax:602-470-5064
Practice Address - Street 1:840 E MCKELLIPS RD
Practice Address - Street 2:SUITE #110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-9645
Practice Address - Country:US
Practice Address - Phone:602-470-5520
Practice Address - Fax:480-649-0783
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DISTRICT MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty