Provider Demographics
NPI:1992735088
Name:DIGNITY HEALTH
Entity type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-728-3144
Mailing Address - Street 1:475 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5605
Mailing Address - Country:US
Mailing Address - Phone:480-963-4561
Mailing Address - Fax:480-728-3875
Practice Address - Street 1:3555 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-7323
Practice Address - Country:US
Practice Address - Phone:480-963-4561
Practice Address - Fax:480-728-3875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-04
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH3972261QU0200X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
352263845852960000OtherWPS TRICARE
AZ7118830OtherAETNA
AZ0922480OtherBCBS AZ - QUEEN CREEK UC
AZAZ0425540OtherBLUE CROSS BLUE SHIELD
AZF15668Medicaid
AZ117030Medicaid
352263845OtherIRS - SP TAX ID
35226384585242A001OtherWPS TRICARE - URGENT CARE
7901892OtherAETNA - QUEEN CREEK UC
AZIZ1012OtherHEALTHNET FACILITY ID
AZ2Z7798OtherHEALTHNET PRO FEE ID
AZ7118830OtherAETNA
7901892OtherAETNA - QUEEN CREEK UC