1821415902 NPI number — MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Table of content: (NPI 1821415902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821415902 NPI number — MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
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:
MARICOPA INTEGRATED HEALTH
Provider Other Organization Name Type Code:
3
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:
1821415902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29670
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:
85038-9670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-344-8178
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8088 W WHITNEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85345-6564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-855-9973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FOWLER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SYSTEM DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
602-344-2830

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  H3673 , 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: 987495 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0947 . This is a "HEALTHNET OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 29517 . This is a "PHOENIX INDIAN MEDICAL CENTER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 500005 . This is a "EVERCARE CHOICE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 631935 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0205850 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 189350800 . This is a "UD DEPT OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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