1023253432 NPI number — EMERGENCY HEALTH PARTNERS-VERDE VALLEY PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023253432 NPI number — EMERGENCY HEALTH PARTNERS-VERDE VALLEY PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY HEALTH PARTNERS-VERDE VALLEY PLC
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:
1023253432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 MONROE AVE NW STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49503-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-915-7933
Provider Business Mailing Address Fax Number:
616-726-1494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 S CANDY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COTTONWOOD
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86326-4158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-639-6172
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EHRLICH
Authorized Official First Name:
MARY ALICE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
616-915-7933

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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