ARCHWELL HEALTH PROFESSIONAL SERVICES OF ARIZONA, LLC
Complete NPI Record 1558026880
Internal Medicine in Mesa, AZ
Active since November 02, 2021CLIA Certified · 14 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Archwell Health Professional Services Of Arizona, Llc (NPI 1558026880), an internal medicine organization in Mesa, AZ. All 33 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1558026880 Field 1/33
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/33
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/33
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: ARCHWELL HEALTH PROFESSIONAL SERVICES OF ARIZONA, LLC Field 4/33
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider First Line Business Mailing Address: 102 WOODMONT BLVD STE 600 Field 5/33
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: NASHVILLE Field 6/33
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: TN Field 7/33
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 372055250 Field 8/33
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 9/33
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider First Line Business Practice Location Address: 4315 E MAIN ST Field 10/33
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: MESA Field 11/33
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: AZ Field 12/33
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 852058605 Field 13/33
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 14/33
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 4808707500 Field 15/33
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 4809062173 Field 16/33
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: MODDESETTE Field 19/33
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: AMY Field 20/33
- The first name of the authorized official.
- Authorized Official Title or Position: SR. DIRECTOR, MANAGED CARE OPS Field 21/33
- The title or position of the authorized official.
- Authorized Official Telephone Number: 6292241614 Field 22/33
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207RG0300X Field 23/33
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 24/33
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 207QG0300X Field 25/33
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 26/33
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 207R00000X Field 27/33
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: Y Field 28/33
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 29/33
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP Field 30/33
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP Field 31/33
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
- Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP Field 32/33
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Secondary Practice Locations 15
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
8913 N 19th Ave
Location 1/15Phoenix, AZ 85021-4206 · Phone (602) 858-4361 · Fax (480) 906-2176
2940 S 6th Ave
Location 2/15Tucson, AZ 85713-4705 · Phone (520) 613-1001 · Fax (520) 504-6483
5455 E Speedway Blvd
Location 3/15Tucson, AZ 85712-4923 · Phone (520) 505-8912 · Fax (888) 355-6926
6843 E Main St
Location 4/15Mesa, AZ 85207-8207 · Phone (480) 870-7300 · Fax (480) 906-2172
9550 E Golf Links Rd Ste 100
Location 5/15Tucson, AZ 85730-1400 · Phone (520) 910-0207 · Fax (855) 576-4748
1740 E Fort Lowell Rd Ste 100
Location 6/15Tucson, AZ 85719-2384 · Phone (520) 613-0001 · Fax (520) 504-6482
17674 N Litchfield Rd
Location 7/15Surprise, AZ 85374-2478 · Phone (623) 281-3001 · Fax (480) 906-2180
9750 W Peoria Ave Ste 120
Location 8/15Peoria, AZ 85345-6108 · Phone (623) 281-1620 · Fax (480) 906-2178
5100 E Broadway Blvd
Location 9/15Tucson, AZ 85711-3762 · Phone (520) 613-3001 · Fax (520) 504-6481
2265 W Ina Rd
Location 10/15Tucson, AZ 85741-2650 · Phone (520) 702-3637 · Fax (855) 576-4111
725 W Apache Trl Ste 4
Location 11/15Apache Junction, AZ 85120-3963 · Phone (480) 870-7130 · Fax (480) 906-2171
4420 E McDowell Rd
Location 12/15Phoenix, AZ 85008-4504 · Phone (602) 858-4295 · Fax (480) 906-2177
1060 E Southern Ave Ste 106
Location 13/15Mesa, AZ 85204-5058 · Phone (480) 870-7400 · Fax (480) 906-2174
10050 W Bell Rd Ste 35
Location 14/15Sun City, AZ 85351-1290 · Phone (623) 281-1130 · Fax (480) 906-2179
4220 W Bethany Home Rd
Location 15/15Phoenix, AZ 85019-1808 · Phone (623) 281-1258 · Fax (480) 906-2175
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