1619366457 NPI number — TREATMENT ASSESSMENT SCREENING CENTER, INC

Table of content: DR. ALI SHAHEEN AL-YAQOOBI M.D. (NPI 1003141417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619366457 NPI number — TREATMENT ASSESSMENT SCREENING CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TREATMENT ASSESSMENT SCREENING CENTER, 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:
6
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:
1619366457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2234 N 7TH ST
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:
85006-1651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-254-7328
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2364 KINGMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86401-4840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-853-8678
Provider Business Practice Location Address Fax Number:
602-712-0235
Provider Enumeration Date:
01/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
602-254-7328

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  OTC5949 , 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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