Provider Demographics
NPI:1053338962
Name:SOUTHWESTERN ARIZONA NEONATOLOGY PLLC.
Entity type:Organization
Organization Name:SOUTHWESTERN ARIZONA NEONATOLOGY PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATOLOGY MEDICAL DIRECTOR,SWAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WARDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-336-7665
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-0050
Mailing Address - Country:US
Mailing Address - Phone:928-783-7283
Mailing Address - Fax:928-783-4257
Practice Address - Street 1:2400 S AVENUE A
Practice Address - Street 2:NICU
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7127
Practice Address - Country:US
Practice Address - Phone:928-336-7665
Practice Address - Fax:928-336-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274662080N0001X
CAC507242080N0001X
CO338792080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ330211OtherAHCCS APIPA
AZ330211OtherAHCCS MERCYCARE
AZ330211OtherAHCCS FFS
AZAZ078006OtherBLUE CROSS BLUE SHEILD