1164682472 NPI number — ENVITA MEDICAL CENTERS

Table of content: (NPI 1164682472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164682472 NPI number — ENVITA MEDICAL CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENVITA MEDICAL CENTERS
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:
1164682472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9343 E BAHIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-569-4144
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8759 E BELL RD
Provider Second Line Business Practice Location Address:
BLDG G
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-569-4144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBLES
Authorized Official First Name:
LACEY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ACCOUNTING MANAGER
Authorized Official Telephone Number:
480-569-2959

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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