1467764514 NPI number — COCHISE DIGESTIVE HEALTH CENTER PLLC

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 1467764514 NPI number — COCHISE DIGESTIVE HEALTH CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COCHISE DIGESTIVE HEALTH CENTER PLLC
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:
1467764514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 COLONIA DE SALUD
Provider Second Line Business Mailing Address:
SUITE 100B
Provider Business Mailing Address City Name:
SIERRA VISTA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85635-2487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-335-6520
Provider Business Mailing Address Fax Number:
520-335-6548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 COLONIA DE SALUD
Provider Second Line Business Practice Location Address:
SUITE 100B
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635-2487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-335-6520
Provider Business Practice Location Address Fax Number:
520-335-6548
Provider Enumeration Date:
07/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DALY
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
MILLER
Authorized Official Title or Position:
PROVIDER/OWNER
Authorized Official Telephone Number:
520-335-6520

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  42912 , 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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