1659454445 NPI number — ARISE PROSTHETICS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659454445 NPI number — ARISE PROSTHETICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARISE PROSTHETICS 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:
ARISE PROSTHETICS
Provider Other Organization Name Type Code:
5
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:
1659454445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1830 W COLTER ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85015-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-864-5560
Provider Business Mailing Address Fax Number:
602-864-4958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1830 W COLTER ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85015-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-864-5560
Provider Business Practice Location Address Fax Number:
602-864-4958
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WERNER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-864-5560

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AZ0278780 . This is a "BLUE CROSS BLUE SHIELD AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 545080 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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