1275074015 NPI number — NICHOLAS A. RANSOM PROFESSIONAL CORPORATION

Table of content: (NPI 1275074015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275074015 NPI number — NICHOLAS A. RANSOM PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NICHOLAS A. RANSOM PROFESSIONAL CORPORATION
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:
NICHOLAS A RANSOM PROFESSIONAL CORPORATION
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:
1275074015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 WEST ST.MARYS ROAD
Provider Second Line Business Mailing Address:
STE 114
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85745-2621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-360-1668
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 W SAINT MARYS RD
Provider Second Line Business Practice Location Address:
STE 114
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-396-4798
Provider Business Practice Location Address Fax Number:
520-495-5287
Provider Enumeration Date:
03/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RANSOM
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
520-396-4798

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  18436 , 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: 286668 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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