1932454881 NPI number — LEY INSTITUTE OF PLASTIC & HAND SURGERY, LLC

Table of content: (NPI 1932454881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932454881 NPI number — LEY INSTITUTE OF PLASTIC & HAND SURGERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEY INSTITUTE OF PLASTIC & HAND SURGERY, LLC
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:
ARIZONA CRANIOFACIAL & PEDIATRIC PLASTIC SURGERY
Provider Other Organization Name Type Code:
5
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:
1932454881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5225 E KNIGHT DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85712-2156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-396-3566
Provider Business Mailing Address Fax Number:
801-396-3548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1517 N WILMOT RD
Provider Second Line Business Practice Location Address:
177
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-4410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-396-3566
Provider Business Practice Location Address Fax Number:
801-396-3548
Provider Enumeration Date:
07/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LEY TAI
Authorized Official First Name:
ELEAZAR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
801-651-8782

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  36876 , 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: 701121 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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