1336339258 NPI number — ARIZONA DEPARTMENT OF CORRECTIONS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336339258 NPI number — ARIZONA DEPARTMENT OF CORRECTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA DEPARTMENT OF CORRECTIONS
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:
Provider Other Organization Name Type Code:
6
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:
1336339258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 W JEFFERSON 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:
85007-3002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-364-2900
Provider Business Mailing Address Fax Number:
602-364-2958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 E VAN BUREN ST
Provider Second Line Business Practice Location Address:
ASPC PHOENIX HEALTH UNIT
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85008-6037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-685-3100
Provider Business Practice Location Address Fax Number:
602-685-3111
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KENDALL
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
BUREAU ADMINISTRATOR
Authorized Official Telephone Number:
602-364-2900

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , 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)





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