1144319849 NPI number — MICHAEL R THYGERSON CRNA

Table of content: MICHAEL R THYGERSON CRNA (NPI 1144319849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144319849 NPI number — MICHAEL R THYGERSON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THYGERSON
Provider First Name:
MICHAEL
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1144319849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLOBE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85502-0386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-961-3902
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5880 S HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLOBE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85501-9447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-961-3902
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  286558-4406 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 70681 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: TPRA08440 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 107013149101 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 190683600 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 28655844000001 . This is a "BCBS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870666269THY . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 780194 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 18330 . This is a "HEALTHY U" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000054865 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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