1902014491 NPI number — BIOMECHANICAL PODIATRY PC

Table of content: (NPI 1902014491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902014491 NPI number — BIOMECHANICAL PODIATRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIOMECHANICAL PODIATRY 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:
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:
1902014491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10789 N 90TH ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-6773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-451-0123
Provider Business Mailing Address Fax Number:
480-451-4876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10789 N 90TH ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-6773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-451-0123
Provider Business Practice Location Address Fax Number:
480-451-4876
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ACCOMANDO
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
480-451-0123

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  338 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 161070481050 . This is a "HUMANA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 378615400 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 442547 . This is a "MMSI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ6123 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0005825224 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0193360 . This is a "BLUE CROSS BLUE SHIELD ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0705963 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 85260 A001 . This is a "WPS TRICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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