1922240407 NPI number — ALAN HARTSOOK M.D.

Table of content: ALAN HARTSOOK M.D. (NPI 1922240407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922240407 NPI number — ALAN HARTSOOK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTSOOK
Provider First Name:
ALAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1922240407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10750 W MCDOWELL RD
Provider Second Line Business Mailing Address:
SUITE G-700
Provider Business Mailing Address City Name:
AVONDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85392-5960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-873-0321
Provider Business Mailing Address Fax Number:
623-849-9623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10750 W MCDOWELL RD
Provider Second Line Business Practice Location Address:
SUITE G-700
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85392-5960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-873-0321
Provider Business Practice Location Address Fax Number:
623-849-9623
Provider Enumeration Date:
03/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  40823 , 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: 446018 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com