1033547088 NPI number — ALETRIS CENTER OF INTEGRATIVE MEDICINE

Table of content: (NPI 1033547088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033547088 NPI number — ALETRIS CENTER OF INTEGRATIVE MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALETRIS CENTER OF INTEGRATIVE MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033547088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7425 E SHEA BLVD STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-6411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-998-2020
Provider Business Mailing Address Fax Number:
480-948-1367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7425 E SHEA BLVD STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-6411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-998-2020
Provider Business Practice Location Address Fax Number:
480-948-1367
Provider Enumeration Date:
10/29/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TERLISNER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
480-998-2020

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  06-969 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13-1402 . This is a "NONE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 06-969 . This is a "NONE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 09-1160 . This is a "NONE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 8268 . This is a "NONE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".