1497865661 NPI number — CATHERINE A DEVORE MEEHAN D.C.

Table of content: CATHERINE A DEVORE MEEHAN D.C. (NPI 1497865661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497865661 NPI number — CATHERINE A DEVORE MEEHAN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVORE MEEHAN
Provider First Name:
CATHERINE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1497865661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8426 W PEORIA AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-979-3998
Provider Business Mailing Address Fax Number:
623-878-5976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8426 W PEORIA AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-979-3998
Provider Business Practice Location Address Fax Number:
623-878-5976
Provider Enumeration Date:
08/30/2006

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: 111N00000X , with the licence number:  4437 , 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: AZ0942420 . This is a "BC BS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 189159000 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2141842 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1011517 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 44-00092 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0030682 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 20110 . This is a "AMERICAN WHOLE HEALTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7642480 . This is a "GHI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00189172 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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