1528051620 NPI number — GREATER ARIZONA GASTROENTEROLOGY & ASSOCIATES PC

Table of content: (NPI 1528051620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528051620 NPI number — GREATER ARIZONA GASTROENTEROLOGY & ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER ARIZONA GASTROENTEROLOGY & ASSOCIATES PC
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:
1528051620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1780 E FLORENCE BLVD
Provider Second Line Business Mailing Address:
#104
Provider Business Mailing Address City Name:
CASA GRANDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85122-4782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-426-1928
Provider Business Mailing Address Fax Number:
520-426-9088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 E FLORENCE BLVD
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
CASA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85122-4782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-426-1928
Provider Business Practice Location Address Fax Number:
520-426-9088
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KAZI
Authorized Official First Name:
NADEEM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-426-1928

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  25728 , 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: AZ0810620 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 628670 . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PIM21KAZINA1 . This is a "MERCYCAREPLAN PREMIUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1Z0212 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 393968 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95964 . This is a "PACIFICARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 601101 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95999 . This is a "PACIFICARE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1002828 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7612839 . This is a "DIVISION OF MEDICAL ASST" identifier . This identifiers is of the category "OTHER".




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