Provider Demographics
NPI:1316961022
Name:OBSTETRIX MEDICAL GROUP OF ARIZONA, P.C.
Entity type:Organization
Organization Name:OBSTETRIX MEDICAL GROUP OF ARIZONA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-256-4628
Mailing Address - Street 1:4722 N 24TH ST
Mailing Address - Street 2:STE. 150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4800
Mailing Address - Country:US
Mailing Address - Phone:602-256-4628
Mailing Address - Fax:855-851-4319
Practice Address - Street 1:5301 E GRANT RD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-795-8188
Practice Address - Fax:520-325-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ434647Medicaid
AZZ65064Medicare PIN
AZ434647Medicaid
AZZ71199Medicare PIN