1366643777 NPI number — TAHIRIH JENSEN D.O. PC

Table of content: MYINT MYAT NOE M.D. (NPI 1316309834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366643777 NPI number — TAHIRIH JENSEN D.O. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAHIRIH JENSEN D.O. PC
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:
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:
1366643777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDONA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86341-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-282-7322
Provider Business Mailing Address Fax Number:
928-282-7350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6050 HIGHWAY 179 STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEDONA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86351-7986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-282-7322
Provider Business Practice Location Address Fax Number:
928-282-7350
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
TAHIRIH
Authorized Official Middle Name:
THEONE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
928-282-7322

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  3985 , 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: 882797 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com