1265536536 NPI number — AZ INSTITUTE OF NEUROLOGY & POLYSOMOGRAPHY P C

Table of content: (NPI 1265536536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265536536 NPI number — AZ INSTITUTE OF NEUROLOGY & POLYSOMOGRAPHY P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AZ INSTITUTE OF NEUROLOGY & POLYSOMOGRAPHY P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
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NPI Number Information

NPI Number:
1265536536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 11225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASA GRANDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85230-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-423-0208
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1653 E MCMURRAY BLVD
Provider Second Line Business Practice Location Address:
SUITE 139
Provider Business Practice Location Address City Name:
CADA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-423-2046
Provider Business Practice Location Address Fax Number:
520-423-0208
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
HABIB
Authorized Official Middle Name:
U
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
520-423-2046

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 504375 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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