1467504738 NPI number — MISS ERIKA M. SLOVER PT

Table of content: MISS ERIKA M. SLOVER PT (NPI 1467504738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467504738 NPI number — MISS ERIKA M. SLOVER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOVER
Provider First Name:
ERIKA
Provider Middle Name:
M.
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1467504738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 304
Provider Second Line Business Mailing Address:
105 FRONTAGE RD., STE.F
Provider Business Mailing Address City Name:
PEARCE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85625-0304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-826-3222
Provider Business Mailing Address Fax Number:
520-826-3222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 FRONTAGE RD., STE.F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARCE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-826-3222
Provider Business Practice Location Address Fax Number:
520-826-3222
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  RPT 1500 , 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: 783078 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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