1194943423 NPI number — NOSSEK REHAB LLC

Table of content: (NPI 1194943423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194943423 NPI number — NOSSEK REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOSSEK REHAB 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:
PAYSON PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1194943423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
PAYSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85541-5333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-474-0429
Provider Business Mailing Address Fax Number:
928-474-0199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
PAYSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85541-5333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-474-0429
Provider Business Practice Location Address Fax Number:
928-474-0199
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NOSSEK
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
928-474-0429

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 194960 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ-1730-1201 . This is a "PTP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0293830 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 64-00187 . This is a "UHC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 670821 . This is a "ACN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 000227851 . This is a "CMDP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1004136 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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