1518905793 NPI number — TON SAN XAVIER HEALTH CENTER

Table of content: (NPI 1518905793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518905793 NPI number — TON SAN XAVIER HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TON SAN XAVIER HEALTH CENTER
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:
TON SAN XAVIER HEALTH CENTER PHARMACY
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:
1518905793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31001-0661
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91110-0661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 S J STOCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85746-7012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-295-2550
Provider Business Practice Location Address Fax Number:
520-295-2609
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHANLEY
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DEPUTY CEO
Authorized Official Telephone Number:
520-383-7285

Provider Taxonomy Codes

  • Taxonomy code: 332800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 147133-03 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14713301 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1991071 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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