1629099387 NPI number — JOHN R ALESSI DO

Table of content: JOHN R ALESSI DO (NPI 1629099387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629099387 NPI number — JOHN R ALESSI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALESSI
Provider First Name:
JOHN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1629099387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86304-0880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-406-4786
Provider Business Mailing Address Fax Number:
916-636-4358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6648 N VIEWPOINT DR STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86315-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-636-5680
Provider Business Practice Location Address Fax Number:
928-636-5853
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  02001677A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 007784 , 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)

  • Identifier: Z255368 . This is a "MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 448808 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC3757 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200062550A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000990240 . This is a "ANTHEM PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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