1205135969 NPI number — EAST VALLEY CRITICAL CARE ASSOCIATES, P.C.

Table of content: (NPI 1205135969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205135969 NPI number — EAST VALLEY CRITICAL CARE ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST VALLEY CRITICAL CARE ASSOCIATES, P.C.
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:
1205135969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6750 E BAYWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 507
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85206-1749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-835-7111
Provider Business Mailing Address Fax Number:
480-218-5706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 S CRISMON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85209-3767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-358-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BASS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
602-717-4751

Provider Taxonomy Codes

  • Taxonomy code: 261QC0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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