1194135152 NPI number — CONNECTIONSAZ, LLC

Table of content: (NPI 1194135152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194135152 NPI number — CONNECTIONSAZ, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNECTIONSAZ, LLC
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:
UPC OUTPATIENT SERVICES
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:
1194135152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3030 N CENTRAL AVE STE 1207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-2719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-253-5100
Provider Business Mailing Address Fax Number:
866-882-5456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 S 7TH AVE STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85007-4075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-416-7600
Provider Business Practice Location Address Fax Number:
866-882-5456
Provider Enumeration Date:
04/30/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANIFOWOSE
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
602-416-7616

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  OTC7437 , 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: 942221 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".