Provider Demographics
NPI:1528305281
Name:AMF GASTROENTEROGY, INC
Entity type:Organization
Organization Name:AMF GASTROENTEROGY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSHDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-309-7716
Mailing Address - Street 1:2902 E GARY WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7107
Mailing Address - Country:US
Mailing Address - Phone:602-309-7716
Mailing Address - Fax:602-279-1720
Practice Address - Street 1:1310 N 24TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008
Practice Address - Country:US
Practice Address - Phone:602-254-6101
Practice Address - Fax:602-279-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28980207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ550899Medicaid
AZH34879Medicare UPIN