1366521049 NPI number — O&P RESEARCH LAB, INC.

Table of content: (NPI 1366521049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366521049 NPI number — O&P RESEARCH LAB, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O&P RESEARCH LAB, 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:
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:
1366521049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6343 E MAIN ST STE B1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85205-8972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-981-7393
Provider Business Mailing Address Fax Number:
480-981-5807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6343 E MAIN ST STE B1
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:
85205-8972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-981-7393
Provider Business Practice Location Address Fax Number:
480-981-5807
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FIKES
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
480-981-7393

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 189707800 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 80702 . This is a "NORTHWOOD NPN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 05-07-1191 . This is a "SCF OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z6986 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 8487650 . This is a "CMDP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0277570 . This is a "BLUE CROSS BLUE SHIELD AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 062090 . This is a "INDUSTRIAL COMMISSION" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: F04300 . This is a "PHOENIX HEALTH PLAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 348765 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52601 . This is a "ANTHEM BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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