1316925886 NPI number — MR. JOSEF KAY BURWELL PA-C

Table of content: MR. JOSEF KAY BURWELL PA-C (NPI 1316925886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316925886 NPI number — MR. JOSEF KAY BURWELL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURWELL
Provider First Name:
JOSEF
Provider Middle Name:
KAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURWELL
Provider Other First Name:
PAMELA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316925886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2322 N 8TH ST
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:
85006-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-909-0404
Provider Business Mailing Address Fax Number:
602-548-2292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2902 W CLARENDON AV
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:
85209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-909-0404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2006

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: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 1915 , 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)