1457659708 NPI number — COMPREHENSIVEWOUND CARE

Table of content: (NPI 1457659708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457659708 NPI number — COMPREHENSIVEWOUND CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVEWOUND CARE
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:
1457659708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16515 S 40TH ST
Provider Second Line Business Mailing Address:
SUITE 139
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85048-0558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-706-0174
Provider Business Mailing Address Fax Number:
480-706-0117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13203 N 103RD AVE
Provider Second Line Business Practice Location Address:
SUITE 1-10
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85351-3028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-706-0174
Provider Business Practice Location Address Fax Number:
480-706-0117
Provider Enumeration Date:
03/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LESTER
Authorized Official First Name:
JODI
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
480-706-0174

Provider Taxonomy Codes

  • Taxonomy code: 2083P0011X , with the licence number:  3344 , 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: 1740489251 . This is a "1740489251" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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