1255487955 NPI number — WRIGHT FAMILY MEDICINE, INC

Table of content: (NPI 1255487955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255487955 NPI number — WRIGHT FAMILY MEDICINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRIGHT FAMILY MEDICINE, INC
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:
1255487955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 W RAY RD
Provider Second Line Business Mailing Address:
STE. 21
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85226-5940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-889-0508
Provider Business Mailing Address Fax Number:
480-889-0511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 W RAY RD
Provider Second Line Business Practice Location Address:
STE. 21
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85226-5940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-889-0508
Provider Business Practice Location Address Fax Number:
480-889-0511
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
LOGAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-889-0508

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  26083 , 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: 418170 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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