1396742912 NPI number — ACTION MEDICAL SERVICE INC.

Table of content: (NPI 1396742912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396742912 NPI number — ACTION MEDICAL SERVICE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTION MEDICAL SERVICE INC.
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:
1396742912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 E SECOND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSLOW
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86047-4130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-289-9229
Provider Business Mailing Address Fax Number:
928-829-6445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 E SECOND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSLOW
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86047-4130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-289-9229
Provider Business Practice Location Address Fax Number:
928-829-6445
Provider Enumeration Date:
06/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEWARD
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
928-289-9229

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  104 , 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: AZ0151910 . This is a "BC/BS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 054578 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: R3158 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".