1760995294 NPI number — SW PHYSICAL MEDICINE AND REHABILITATION, PLLC

Table of content: (NPI 1760995294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760995294 NPI number — SW PHYSICAL MEDICINE AND REHABILITATION, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SW PHYSICAL MEDICINE AND REHABILITATION, 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:
REBECCA T. ARMENDARIZ, MD, PLLC
Provider Other Organization Name Type Code:
5
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:
1760995294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDONA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86336-5503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-386-9181
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2650 N WYATT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-6106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-325-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ARMENDARIZ
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
TERESA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
804-386-9181

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  47934 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081H0002X , with the licence number: 47934 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 12172540 . This is a "CAQH NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 835234 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073773818 . This is a "INDIV NPI #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760995294 . This is a "NPI TYPE 2" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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