1730359688 NPI number — ALLAN M. ANHALT

Table of content: (NPI 1730359688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730359688 NPI number — ALLAN M. ANHALT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLAN M. ANHALT
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:
6
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:
1730359688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 E VIRGINIA AVE
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85004-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-258-3620
Provider Business Mailing Address Fax Number:
602-258-1593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2122 N CRAYCROFT RD
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-325-3121
Provider Business Practice Location Address Fax Number:
602-258-1593
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ANHALT
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-258-3620

Provider Taxonomy Codes

  • Taxonomy code: 156FX1700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 351487 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com