1174727754 NPI number — DR. KATHERINE L. GILLASPY M.D.

Table of content: CHRISTINA M LINKIEWICZ P.A.-C (NPI 1346283694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174727754 NPI number — DR. KATHERINE L. GILLASPY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLASPY
Provider First Name:
KATHERINE
Provider Middle Name:
L.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1174727754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2424 N WYATT DR STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85712-6118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-795-0608
Provider Business Mailing Address Fax Number:
520-795-0354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6261 N LA CHOLLA BLVD STE 277
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85741-3564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-877-3800
Provider Business Practice Location Address Fax Number:
520-877-3801
Provider Enumeration Date:
06/14/2007

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: 207V00000X , with the licence number:  BP1-0026297 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 518266 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3858222709 . This is a "MYUTMB 3858222709-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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