Provider Demographics
NPI:1962420208
Name:HEALTHCARE MANAGEMENT GROUP, LLC.
Entity type:Organization
Organization Name:HEALTHCARE MANAGEMENT GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:505-921-1234
Mailing Address - Street 1:20875 N PIMA RD PMB 206
Mailing Address - Street 2:#C-4
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9194
Mailing Address - Country:US
Mailing Address - Phone:505-921-1234
Mailing Address - Fax:
Practice Address - Street 1:15468 N. CIVIC CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SUPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:623-584-2917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29610207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty