1033385414 NPI number — AVALOS ANESTHESIA SERVICES INC.

Table of content: (NPI 1033385414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033385414 NPI number — AVALOS ANESTHESIA SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVALOS ANESTHESIA SERVICES INC.
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:
1033385414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 BLACK HILLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86324-3734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-368-8118
Provider Business Mailing Address Fax Number:
928-368-8121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
651 W MINGUS AVE STE 2A
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:
86326-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-649-4480
Provider Business Practice Location Address Fax Number:
928-634-8118
Provider Enumeration Date:
05/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AVALOS
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
928-368-8118

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  AZ18262 , 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: 750316 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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