1942287487 NPI number — ARROWHEAD ANESTHESIA ASSOCIATES

Table of content: (NPI 1942287487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942287487 NPI number — ARROWHEAD ANESTHESIA ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARROWHEAD ANESTHESIA ASSOCIATES
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:
1942287487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92324-0007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-783-9111
Provider Business Mailing Address Fax Number:
909-783-9112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 N PEPPER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92324-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-580-2440
Provider Business Practice Location Address Fax Number:
909-580-2441
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ENGWALL
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-580-2440

Provider Taxonomy Codes

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

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

  • Identifier: CK7277 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0092530 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ05898Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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