1235634346 NPI number — ZIA HEALTHCARE SERVICES LLC

Table of content: (NPI 1235634346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235634346 NPI number — ZIA HEALTHCARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZIA HEALTHCARE SERVICES 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:
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:
1235634346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
168 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RATON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87740-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-445-0276
Provider Business Mailing Address Fax Number:
505-445-0284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
168 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RATON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-445-5563
Provider Business Practice Location Address Fax Number:
575-445-8929
Provider Enumeration Date:
03/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ZMILY
Authorized Official First Name:
MISBAH
Authorized Official Middle Name:
DARWEESH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
575-445-5563

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1285735332 . This is a "NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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