1003229295 NPI number — COMMUNITY HEALTH AND IMMUNIZATION SERVICES

Table of content: (NPI 1003229295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003229295 NPI number — COMMUNITY HEALTH AND IMMUNIZATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH AND IMMUNIZATION SERVICES
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:
1003229295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8324 E HARTFORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85255-5466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-358-8646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10730 PACIFIC ST
Provider Second Line Business Practice Location Address:
SUITE 221 B
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-4799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-715-9308
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
KARA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF COMMUNITY DEVELOPMENT
Authorized Official Telephone Number:
480-646-9031

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , with the licence number:  19357 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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