1720145378 NPI number — ACUMEN FISCAL AGENT LLC

Table of content: (NPI 1720145378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720145378 NPI number — ACUMEN FISCAL AGENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACUMEN FISCAL AGENT 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:
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:
1720145378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5416 E BASELINE RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85206-4704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-295-3328
Provider Business Mailing Address Fax Number:
480-339-2123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5416 E BASELINE RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-295-3328
Provider Business Practice Location Address Fax Number:
480-339-2123
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AUER
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
877-211-3738

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116315900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3236199A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717669748B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717669748G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717669748C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717669748I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717669748A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717669748E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3240064A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717669748D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717669748F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717669748H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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