1801867288 NPI number — MS. JULIE MARIE PASSARGE MC

Table of content: MS. JULIE MARIE PASSARGE MC (NPI 1801867288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801867288 NPI number — MS. JULIE MARIE PASSARGE MC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASSARGE
Provider First Name:
JULIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MC
Provider Gender Code:
F

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:
1801867288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17052 NORTH 89TH PLACE
Provider Second Line Business Mailing Address:
SUITE 221
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-332-6709
Provider Business Mailing Address Fax Number:
480-247-2400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17052 NORTH 89TH PLACE
Provider Second Line Business Practice Location Address:
SUITE 221
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-332-6709
Provider Business Practice Location Address Fax Number:
480-247-2400
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC 10101 , 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)

  • Identifier: 11533436 . This is a "CIQH PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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