1174847016 NPI number — ABRAZO MEDICAL GROUP URGENT CARE LLC

Table of content: (NPI 1174847016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174847016 NPI number — ABRAZO MEDICAL GROUP URGENT CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABRAZO MEDICAL GROUP URGENT CARE LLC
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:
1174847016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 BURTON HILLS BLVD
Provider Second Line Business Mailing Address:
SUITE 100 - ATTN: CAROL BAILEY
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-665-6000
Provider Business Mailing Address Fax Number:
615-665-6184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6565 E GREENWAY PKWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85254-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-665-6000
Provider Business Practice Location Address Fax Number:
615-665-6184
Provider Enumeration Date:
03/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
615-665-6000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 526251 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com