1477789170 NPI number — SAGUARO INTERNAL MEDICINE, PLLC

Table of content: (NPI 1477789170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477789170 NPI number — SAGUARO INTERNAL MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAGUARO INTERNAL MEDICINE, 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:
SAGUARO INTERNAL MEDICINE
Provider Other Organization Name Type Code:
5
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:
1477789170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14506 W GRANITE VALLEY DR
Provider Second Line Business Mailing Address:
STE 225
Provider Business Mailing Address City Name:
SUN CITY WEST
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85375-6010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-546-0007
Provider Business Mailing Address Fax Number:
623-584-6915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14506 W GRANITE VALLEY DR
Provider Second Line Business Practice Location Address:
STE 225
Provider Business Practice Location Address City Name:
SUN CITY WEST
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85375-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-546-0007
Provider Business Practice Location Address Fax Number:
623-584-6915
Provider Enumeration Date:
06/09/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SARMA
Authorized Official First Name:
SATYA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
623-546-0007

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD22681 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0100X , with the licence number: MD22681 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 179342 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0382500 . This is a "BLUE CROSS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".