1376512798 NPI number — INSIGHT HEALTH CORP

Table of content: (NPI 1376512798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376512798 NPI number — INSIGHT HEALTH CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT HEALTH CORP
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:
1376512798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FILE 57174
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-7174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-282-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1940 S COUNTRY CLUB DR
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85210-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-730-5300
Provider Business Practice Location Address Fax Number:
480-756-2440
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STANLEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER; TREASURER
Authorized Official Telephone Number:
949-282-6000

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 303824 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470000900 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 522179 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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