Provider Demographics
NPI:1982087532
Name:HOSPICE MD PLLC
Entity type:Organization
Organization Name:HOSPICE MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:VILLAMOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-237-3440
Mailing Address - Street 1:2416 W ESPARTERO WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-5525
Mailing Address - Country:US
Mailing Address - Phone:623-237-3440
Mailing Address - Fax:480-685-8379
Practice Address - Street 1:2635 N DYSART RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-2001
Practice Address - Country:US
Practice Address - Phone:623-237-3440
Practice Address - Fax:480-685-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47017207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ47017OtherAZ LICENSE