1891834552 NPI number — M.B. BEST MEDICAL GROUP, INC.

Table of content: (NPI 1891834552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891834552 NPI number — M.B. BEST MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M.B. BEST MEDICAL GROUP, INC.
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:
DBA MINOR FAMILY PRACTICE GROUP
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:
1891834552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8618 N 35TH AVE
Provider Second Line Business Mailing Address:
3
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85051-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-249-0999
Provider Business Mailing Address Fax Number:
602-249-6020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8618 N 35TH AVE
Provider Second Line Business Practice Location Address:
3
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85051-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-249-0999
Provider Business Practice Location Address Fax Number:
602-249-6020
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LANCHIAN
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
818-303-6737

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34954 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 3290 , 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: 237455 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 271924 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620957 . This is a "AETNA-LEROY KAREUS DO" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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