1790889319 NPI number — CLM MEDICAL MANAGEMENT PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790889319 NPI number — CLM MEDICAL MANAGEMENT PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLM MEDICAL MANAGEMENT PLC
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:
1790889319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAREFREE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85377-5925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-488-9220
Provider Business Mailing Address Fax Number:
480-488-7014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36889 N TOM DARLINGTON DR
Provider Second Line Business Practice Location Address:
SUITE A4
Provider Business Practice Location Address City Name:
CAREFREE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85377-5925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-488-9220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHATTMAN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
SETH
Authorized Official Title or Position:
MEMBER DIRECTOR
Authorized Official Telephone Number:
480-488-9220

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OTC3627 . This is a "AZ DEPT OF HEALTH SERVICE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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