1144387978 NPI number — ARIZONA STATE UNIVERSITY

Table of content: (NPI 1144387978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144387978 NPI number — ARIZONA STATE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA STATE UNIVERSITY
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:
ASU HEALTH SERVICES DOWNTOWN NP HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1144387978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 N 3RD ST
Provider Second Line Business Mailing Address:
SUITE 155
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85004-2135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-496-0721
Provider Business Mailing Address Fax Number:
602-496-0675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85004-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-496-0721
Provider Business Practice Location Address Fax Number:
602-496-0675
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
602-496-0665

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , 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: Z21383 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 207841 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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