1356668644 NPI number — HOSEA E BROWN MD INC

Table of content: (NPI 1356668644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356668644 NPI number — HOSEA E BROWN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSEA E BROWN MD 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:
1356668644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92263-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-320-9464
Provider Business Mailing Address Fax Number:
760-320-6244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3755 KARICIO LN
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86303-6836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-445-4645
Provider Business Practice Location Address Fax Number:
760-320-6244
Provider Enumeration Date:
04/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
HOSEA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
760-320-9464

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X , with the licence number:  24719 , 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: 365975 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0803500 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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