1699027201 NPI number — ERNEST L HARMAN MD ZIA WAY LLC

Table of content: (NPI 1699027201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699027201 NPI number — ERNEST L HARMAN MD ZIA WAY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERNEST L HARMAN MD ZIA WAY LLC
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:
ZIA WAY
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:
1699027201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3880 N STOCKTON HILL RD STE 103134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGMAN
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86409-0595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-377-1615
Provider Business Mailing Address Fax Number:
928-692-1888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5036 STOCKTON HILL RD
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:
86409-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-377-1615
Provider Business Practice Location Address Fax Number:
928-692-1888
Provider Enumeration Date:
10/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HARMAN
Authorized Official First Name:
ERNEST
Authorized Official Middle Name:
LAVERE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
628-377-1615

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  24649 , 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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