1457794414 NPI number — NORTHERN ARIZONA HEALTHCARE SOLUTIONS P.C.

Table of content: (NPI 1457794414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457794414 NPI number — NORTHERN ARIZONA HEALTHCARE SOLUTIONS P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ARIZONA HEALTHCARE SOLUTIONS P.C.
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:
1457794414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1778 N HWY 89
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINO VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86323-5695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-404-1488
Provider Business Mailing Address Fax Number:
602-218-4443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1778 N HWY 89
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINO VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86323-5695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-404-1488
Provider Business Practice Location Address Fax Number:
602-218-4443
Provider Enumeration Date:
04/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
928-772-1673

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP4015 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: F1108184 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: Z91357 . This is a "PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z128381 . This is a "PTAN" identifier . This identifiers is of the category "OTHER".




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