1992735088 NPI number — DIGNITY HEALTH

Table of content: (NPI 1992735088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992735088 NPI number — DIGNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGNITY HEALTH
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:
6
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:
1992735088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 S DOBSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85224-5605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-275-8112
Provider Business Mailing Address Fax Number:
779-803-8118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3555 S VAL VISTA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85296-7323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-275-8112
Provider Business Practice Location Address Fax Number:
779-803-8118
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORISSETTE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
858-275-8112

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  H3972 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: H3972 , 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: 117030 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2Z7798 . This is a "HEALTHNET PRO FEE ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0922480 . This is a "BCBS AZ - QUEEN CREEK UC" identifier . This identifiers is of the category "OTHER".
  • Identifier: IZ1012 . This is a "HEALTHNET FACILITY ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 352263845 . This is a "IRS - SP TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: F15668 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35226384585242A001 . This is a "WPS TRICARE - URGENT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 352263845852960000 . This is a "WPS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7901892 . This is a "AETNA - QUEEN CREEK UC" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ0425540 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7118830 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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