1538588405 NPI number — PODIATRIC FIRST ASSIST PLC

Table of content: (NPI 1538588405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538588405 NPI number — PODIATRIC FIRST ASSIST PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRIC FIRST ASSIST PLC
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:
PODIATRIC FIRST ASSIST PLC
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:
1538588405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 153
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN TAN VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85142-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-677-4651
Provider Business Mailing Address Fax Number:
480-840-3458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 W COMBS RD
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
SAN TAN VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85140-9105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-677-4651
Provider Business Practice Location Address Fax Number:
480-840-3458
Provider Enumeration Date:
04/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SOTA
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
623-234-8131

Provider Taxonomy Codes

  • Taxonomy code: 211D00000X , with the licence number:  0727 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 211D00000X , with the licence number: 0762 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 211D00000X , with the licence number: 575 , 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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