1114092459 NPI number — APOGEE MEDICAL GROUP VERMONT PC

Table of content: MIDIAN AMBO (NPI 1598323370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114092459 NPI number — APOGEE MEDICAL GROUP VERMONT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APOGEE MEDICAL GROUP VERMONT PC
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:
1114092459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 708729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070-8729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-869-2395
Provider Business Mailing Address Fax Number:
801-352-9502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 E CAMELBACK RD
Provider Second Line Business Practice Location Address:
1100
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-778-3600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARWELL
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
602-778-3600

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013714 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 69831 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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