1932186335 NPI number — DESERT SUN MEDICAL CORPORATION PC

Table of content: (NPI 1932186335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932186335 NPI number — DESERT SUN MEDICAL CORPORATION PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESERT SUN MEDICAL CORPORATION 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:
ADVANCED URGENT CARE
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:
1932186335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32950
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-433-1822
Provider Business Mailing Address Fax Number:
602-246-7060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1804 W ELLIOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-456-0444
Provider Business Practice Location Address Fax Number:
480-456-0449
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BISKUPSKI
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
602-433-1822

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  OTC2700 , 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: 630633 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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