1659764173 NPI number — LUKE W GARCIA DO PLLC

Table of content: (NPI 1659764173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659764173 NPI number — LUKE W GARCIA DO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUKE W GARCIA DO 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:
PRECISION PAIN MANAGEMENT
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:
1659764173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 E MCDOWELL RD
Provider Second Line Business Mailing Address:
107-428
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85004-1549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9515 W. CAMELBACK RD.
Provider Second Line Business Practice Location Address:
#126
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-299-9630
Provider Business Practice Location Address Fax Number:
602-595-0922
Provider Enumeration Date:
03/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
LUKE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
480-220-5474

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  006087 , 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: 023033 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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