1669692331 NPI number — PATIENT CARE INFUSION

Table of content: (NPI 1669692331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669692331 NPI number — PATIENT CARE INFUSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENT CARE INFUSION
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:
ARIZONA HOME CARE
Provider Other Organization Name Type Code:
3
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:
1669692331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1626 S EDWARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85281-6200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-252-5000
Provider Business Mailing Address Fax Number:
602-323-5070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1626 S EDWARD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-252-5000
Provider Business Practice Location Address Fax Number:
602-323-5070
Provider Enumeration Date:
04/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COSTON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
AR MANAGER
Authorized Official Telephone Number:
602-252-5000

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  303 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: 303 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 312512 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".