1821189416 NPI number — THOMAS N GLOW DPM PC

Table of content: (NPI 1821189416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821189416 NPI number — THOMAS N GLOW DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS N GLOW DPM PC
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:
1821189416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3965 FOOTHILLS DR
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
SIERRA VISTA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-458-6838
Provider Business Mailing Address Fax Number:
520-458-0373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3965 FOOTHILLS DR
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-458-6838
Provider Business Practice Location Address Fax Number:
520-458-0373
Provider Enumeration Date:
09/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GLOW
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-458-6838

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  87 , 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)