1336132034 NPI number — MR. JASON W ARNETT P.A.

Table of content: SARAH AMBER TERRY OTR/L (NPI 1154551323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336132034 NPI number — MR. JASON W ARNETT P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNETT
Provider First Name:
JASON
Provider Middle Name:
W
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
M

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:
1336132034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30010N 59TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAVE CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85331-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-828-4250
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20950 N TATUM BLVD
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85050-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-502-6651
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  2475 , 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: P00662145 . This is a "MEDICARE RAILROAD/ DERMATOLOGY VEIN AND LASER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00633844 . This is a "RAILROAD MEDICARE WEST DERM OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00809245 . This is a "RR MEDICARE FOR GROUP PTAN#DP3049" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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