1376638452 NPI number — ARIZONA INDUSTRIAL, SPORT & SPINE, INC.

Table of content: (NPI 1376638452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376638452 NPI number — ARIZONA INDUSTRIAL, SPORT & SPINE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA INDUSTRIAL, SPORT & SPINE, 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:
1376638452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26439 S TANGELO AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEEN CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85142-8038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-897-9016
Provider Business Mailing Address Fax Number:
480-718-8494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26439 S TANGELO AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEEN CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85142-8038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-897-9016
Provider Business Practice Location Address Fax Number:
480-718-8494
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
OWNER/ CORPORATE PRESIDENT
Authorized Official Telephone Number:
480-897-9016

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  2113 , 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: A-100786 . This is a "MULTI PLAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: TC00885 . This is a "TRI CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 497630 . This is a "ONE HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2Z9327 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: QH9011 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 378646200 . This is a "OWCP DOL" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7799540 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0462410 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 164065 (852) . This is a "FIRST HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 670917 . This is a "ACN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: A-100786 . This is a "BCE EMERGIS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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