1497528418 NPI number — TWELFTH ONE, LLC

Table of content: (NPI 1497528418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497528418 NPI number — TWELFTH ONE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWELFTH ONE, LLC
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:
ASPEN INFUSION
Provider Other Organization Name Type Code:
3
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:
1497528418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 248819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73124-8819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-739-6040
Provider Business Mailing Address Fax Number:
480-739-6072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2095 S COOPER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85286-7155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-739-6040
Provider Business Practice Location Address Fax Number:
480-739-6072
Provider Enumeration Date:
11/01/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAIEFSKI
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-739-6040

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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