1992799662 NPI number — MR. JOHN ANDREW NELSON P.A.-C

Table of content: MR. JOHN ANDREW NELSON P.A.-C (NPI 1992799662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992799662 NPI number — MR. JOHN ANDREW NELSON P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
JOHN
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
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:
1992799662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18444 N 25TH AVE STE 310
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:
85023-1266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-974-2673
Provider Business Mailing Address Fax Number:
866-939-2673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 S DOBSON RD STE 202
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:
85202-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-974-2673
Provider Business Practice Location Address Fax Number:
866-974-2673
Provider Enumeration Date:
09/08/2005

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: 363A00000X , with the licence number:  6722 , 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: IL0105 . This is a "JOHN DEERE HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 05732036 . This is a "BLUE SHIELD GROUP NUMBERT" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 068816 . This is a "HEALTH ALLIANCE PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 085000447003 . This is a "OSF HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 661684 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37945 . This is a "TIRCARE" identifier . This identifiers is of the category "OTHER".




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