1871589051 NPI number — CASA GRANDE EMERGENCY PHYSICIANS PLLC

Table of content: (NPI 1871589051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871589051 NPI number — CASA GRANDE EMERGENCY PHYSICIANS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASA GRANDE EMERGENCY PHYSICIANS PLLC
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:
1871589051
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:
PO BOX 847854
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-7854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-377-8721
Provider Business Mailing Address Fax Number:
304-523-2241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 E FLORENCE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85222-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-381-6300
Provider Business Practice Location Address Fax Number:
520-381-6618
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HUMAN
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
520-381-6300

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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