1689871667 NPI number — JOHN R MARKHAM PC

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 1689871667 NPI number — JOHN R MARKHAM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN R MARKHAM 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:
PRESCOTT VISION AND EYE SURGERY CENTER
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:
1689871667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3192 WILLOW CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86301-6610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-778-3950
Provider Business Mailing Address Fax Number:
928-778-3999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1680 WILLOW CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86301-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-778-3950
Provider Business Practice Location Address Fax Number:
928-778-3999
Provider Enumeration Date:
07/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARKHAM
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
928-778-3950

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  142 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 1885 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , 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: 3421045 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7442967 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: DM2NNP . This is a "ARIZONA FOUNDATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: NNP12599 . This is a "UNIVERSAL HEALTH CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 033176-001 . This is a "MERCYCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 866291-9714 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 033176 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 190721 . This is a "AHCCCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3Z0277 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0142 . This is a "EYECARE DIRECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1263119 . This is a "MERCYCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 190721 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5858351 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 033176 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 153165 . This is a "RAN-AMN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 63119 . This is a "MEDICARE - UNSPECIFIED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15220 . This is a "AVESIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: A00148 . This is a "EYEMED" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ01170 . This is a "MEDICARE SUBMITTER ID - CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ0142 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".




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