1902877855 NPI number — MAYO CLINIC ARIZONA

Table of content: (NPI 1902877855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902877855 NPI number — MAYO CLINIC ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYO CLINIC ARIZONA
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:
MAYO CLINIC HOSPITAL (PHARMACY)
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:
1902877855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/06/2012
NPI Reactivation Date:
10/10/2012

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13400 E SHEA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85259-5404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-301-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5777 E MAYO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85054-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-301-0881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VIRAMONTES
Authorized Official First Name:
ALLISOON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
480-301-9748

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  4044 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 4044 , 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)





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