1851359293 NPI number — DHHS-PHS, IHS TUCSON AREA

Table of content: (NPI 1851359293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851359293 NPI number — DHHS-PHS, IHS TUCSON AREA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHHS-PHS, IHS TUCSON AREA
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:
IHS TUCSON SANTA ROSA CLINIC
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:
1851359293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7900 S J STOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85746-7012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-295-2427
Provider Business Mailing Address Fax Number:
520-295-2611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FEDERAL ROUTE 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ROSA VILLAGE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-361-2261
Provider Business Practice Location Address Fax Number:
520-383-5572
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRIESSMAN
Authorized Official First Name:
KURT
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTING AND BUGET OFFICER
Authorized Official Telephone Number:
520-295-2427

Provider Taxonomy Codes

  • Taxonomy code: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0327177 . This is a "NACADP #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 706921-01 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 907008-01 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147141-03 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0490080 . This is a "BC/BS AZ PROVIDER #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1770581639 . This is a "FACILITY NPI #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com