1083270854 NPI number — VISION WITH WINGS

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 1083270854 NPI number — VISION WITH WINGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION WITH WINGS
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:
1083270854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9617 N. METRO PKWY WEST
Provider Second Line Business Mailing Address:
STE. 1214 BOX 88
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-870-3759
Provider Business Mailing Address Fax Number:
866-627-0684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9617 N. METRO PKWY WEST
Provider Second Line Business Practice Location Address:
STE. 1214
Provider Business Practice Location Address City Name:
PHOENIZ
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-870-3759
Provider Business Practice Location Address Fax Number:
866-627-0684
Provider Enumeration Date:
05/16/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
602-870-3759

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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