1063503530 NPI number — COUNTY OF YUMA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063503530 NPI number — COUNTY OF YUMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF YUMA
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:
YUMA COUNTY PUBLIC HEALTH SERVICES DISTRICT
Provider Other Organization Name Type Code:
5
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:
1063503530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 W 28TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-317-4550
Provider Business Mailing Address Fax Number:
928-317-4591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 W 28TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-317-4550
Provider Business Practice Location Address Fax Number:
928-317-4591
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
928-317-4550

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  OTC 0285 , 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: 062894 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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