1073699112 NPI number — AIMS PHYSICIANS AND SURGEONS

Table of content: (NPI 1073699112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073699112 NPI number — AIMS PHYSICIANS AND SURGEONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIMS PHYSICIANS AND SURGEONS
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:
1073699112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3636 NORTH STOCKTON HILL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGMAN
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86409-0514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-757-3636
Provider Business Mailing Address Fax Number:
928-757-7224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3636 STOCKTON HILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-757-3636
Provider Business Practice Location Address Fax Number:
928-757-3622
Provider Enumeration Date:
10/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
AZAM
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
928-757-3636

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 03D2044249 . This is a "CLIA NUMBER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 400817 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".