1083098677 NPI number — APEXNETWORK SIERRA VISTA, PLLC

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 1083098677 NPI number — APEXNETWORK SIERRA VISTA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEXNETWORK SIERRA VISTA, PLLC
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:
1083098677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 APEX DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62249-1282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-441-0482
Provider Business Mailing Address Fax Number:
618-441-0482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2151 S HIGHWAY 92
Provider Second Line Business Practice Location Address:
STE. 106
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635-5282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-335-1615
Provider Business Practice Location Address Fax Number:
520-335-1623
Provider Enumeration Date:
07/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MILLIGAN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
520-335-1615

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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