1821261108 NPI number — WRIGHT PAIN MANAGEMENT INC

Table of content: (NPI 1821261108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821261108 NPI number — WRIGHT PAIN MANAGEMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRIGHT PAIN MANAGEMENT INC
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:
1821261108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85070-4568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-361-7680
Provider Business Mailing Address Fax Number:
480-361-7683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13065 W MCDOWELL RAOD
Provider Second Line Business Practice Location Address:
SUITE C-101
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85392-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-535-5629
Provider Business Practice Location Address Fax Number:
623-535-5639
Provider Enumeration Date:
04/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT OF COMPANY
Authorized Official Telephone Number:
623-433-0199

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  34682 , 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: 971475 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2Z8001 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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