1164414447 NPI number — EAST VALLEY ENDOSCOPY LLC

Table of content: (NPI 1164414447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164414447 NPI number — EAST VALLEY ENDOSCOPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST VALLEY ENDOSCOPY LLC
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:
1164414447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1A BURTON HILLS BLVD # L&C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-665-1283
Provider Business Mailing Address Fax Number:
615-234-1720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6020 E ARBOR AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-6102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-830-2005
Provider Business Practice Location Address Fax Number:
480-830-2405
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SNODGRASS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  OSC3368 , 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: 5441198 . This is a "CCN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0208590 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: IZ9438 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 68-03446 . This is a "EVERCARE CHOICE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 769862 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5166126-001 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0020884 . This is a "PHYSICIANHEALTHORGANIZATI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: A-133702 . This is a "MULTIPLAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2047910 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 874634 . This is a "USA/MCO" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0208590 . This is a "TRIWEST" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com