1023055399 NPI number — TOWN OF TAYLOR

Table of content: (NPI 1023055399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023055399 NPI number — TOWN OF TAYLOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF TAYLOR
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:
1023055399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAYLOR
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85939-0158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-536-7900
Provider Business Mailing Address Fax Number:
928-536-6122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 PAPERMILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85939-0158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-536-7900
Provider Business Practice Location Address Fax Number:
928-536-6122
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURDEN
Authorized Official First Name:
CLINT
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
928-536-7900

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 072562 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000R354S , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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