1699023952 NPI number — TARA TRANS

Table of content: COLLEEN MARIE KNAUPP P.A. (NPI 1346373396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699023952 NPI number — TARA TRANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TARA TRANS
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:
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:
1699023952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8237 E MCDONALD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85250-6217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-228-4098
Provider Business Mailing Address Fax Number:
480-323-2374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8237 E MCDONALD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85250-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-228-4098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OMAR
Authorized Official First Name:
GALALELDIN
Authorized Official Middle Name:
EISSA
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
480-228-4098

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  L17496308 , 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: 703516 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 703516 . This is a "INDIAN HEALTH SERVICE (IHS)" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".