1912053752 NPI number — EMERGENCY PHYSICIANS SOUTHWEST, PC

Table of content: (NPI 1912053752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912053752 NPI number — EMERGENCY PHYSICIANS SOUTHWEST, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY PHYSICIANS SOUTHWEST, 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:
1912053752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635623
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-924-1600
Provider Business Mailing Address Fax Number:
925-924-0506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6644 E BAYWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-321-2000
Provider Business Practice Location Address Fax Number:
480-321-4198
Provider Enumeration Date:
01/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARDY
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PROVIDER ENROLLMENT
Authorized Official Telephone Number:
925-251-6901

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 443747 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF7231 . This is a "MEDICARE RR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 012655300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".