1346324514 NPI number — ELIZAGA & ELIZAGA ASSOCIATES, INC.

Table of content: (NPI 1346324514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346324514 NPI number — ELIZAGA & ELIZAGA ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIZAGA & ELIZAGA ASSOCIATES, INC.
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:
1346324514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 SUNSET BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
STEUBENVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43952-1380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-282-5349
Provider Business Mailing Address Fax Number:
740-282-5340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1524 SUNSET BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
STEUBENVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43952-1380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-282-5349
Provider Business Practice Location Address Fax Number:
740-282-5340
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELIZAGA
Authorized Official First Name:
TEODORA
Authorized Official Middle Name:
BALQUIEDRA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-282-5349

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  35.037113 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1807015000 . This is a "WV WELFARE PROVIDER #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: A37113 . This is a "HEALTH PLAN PROVIDER #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 095443212001 . This is a "MED MUT PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000128366 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0022513 . This is a "BOX 24K MT STATE BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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