1528101284 NPI number — DIGNITY HEALTH

Table of content: (NPI 1528101284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528101284 NPI number — DIGNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGNITY HEALTH
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:
ST. ROSE DOMINICAN HOSPITAL, SAN MARTIN CAMPUS
Provider Other Organization Name Type Code:
3
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:
1528101284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3033 N 3RD AVE
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:
85013-4447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-307-2420
Provider Business Mailing Address Fax Number:
602-798-9655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8280 W WARM SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89113-3612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-492-8000
Provider Business Practice Location Address Fax Number:
702-616-5511
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALTERS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
702-616-5507

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  4576HOS0 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 383730230 . This is a "IRS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100511422 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100511423 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100511424 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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