1831397512 NPI number — SIERRA VISTA INTERNAL MEDICINE, PLLC

Table of content: MICHELLE MARIE PETERS PT (NPI 1700592474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831397512 NPI number — SIERRA VISTA INTERNAL MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIERRA VISTA INTERNAL MEDICINE, PLLC
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:
1831397512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 COLONIA DE SALUD
Provider Second Line Business Mailing Address:
SUITE 200A
Provider Business Mailing Address City Name:
SIERRA VISTA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85635-2487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-458-8145
Provider Business Mailing Address Fax Number:
877-771-1056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 COLONIA DE SALUD
Provider Second Line Business Practice Location Address:
SUITE 200A
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635-2487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-458-8145
Provider Business Practice Location Address Fax Number:
877-771-1056
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWNING
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
520-458-8145

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  E76714 , 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)





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