Provider Demographics
NPI:1285064733
Name:ATLANTIS MULTISPECIALTY GROUP OF ARIZONA I LLC
Entity type:Organization
Organization Name:ATLANTIS MULTISPECIALTY GROUP OF ARIZONA I LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:TOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-432-8813
Mailing Address - Street 1:PO BOX 14367
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-4367
Mailing Address - Country:US
Mailing Address - Phone:318-424-4008
Mailing Address - Fax:318-424-6606
Practice Address - Street 1:2155 E CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2604
Practice Address - Country:US
Practice Address - Phone:602-432-8813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty