1063614741 NPI number — SPEECH CENTER OF SOUTHERN ARIZONA

Table of content: (NPI 1063614741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063614741 NPI number — SPEECH CENTER OF SOUTHERN ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH CENTER OF SOUTHERN ARIZONA
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:
1063614741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 E RIVER RD
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85718-5993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-721-4544
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 E RIVER RD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85718-5993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-721-4544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
520-721-4544

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  00000174 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 00135236 , 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: 1386080281 . This is a "NPI - NANCY TURMAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1386788016 . This is a "NPI-DIANE HANSEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 144725 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115742 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104114842 . This is a "NPI - CHRISTINE BUTALLA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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