1508420019 NPI number — ARCA

Table of content: KAYLA ELLEN COOK CMS (NPI 1043803596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508420019 NPI number — ARCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARCA
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:
1508420019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11200 LOMAS BLVD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87112-5514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-332-6832
Provider Business Mailing Address Fax Number:
505-332-6719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1503 4TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-274-4442
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ALMOND
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
ACCOUNTING MANAGER
Authorized Official Telephone Number:
505-332-6832

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15587339 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com