1528051620 NPI number — GREATER ARIZONA GASTROENTEROLOGY & ASSOCIATES PC

Table of content: MS. PATRICIA JUDITH DOHERTY LICSW (NPI 1588838973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528051620 NPI number — GREATER ARIZONA GASTROENTEROLOGY & ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER ARIZONA GASTROENTEROLOGY & ASSOCIATES PC
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:
1528051620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1780 E FLORENCE BLVD
Provider Second Line Business Mailing Address:
#104
Provider Business Mailing Address City Name:
CASA GRANDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85122-4782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-426-1928
Provider Business Mailing Address Fax Number:
520-426-9088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 E FLORENCE BLVD
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
CASA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85122-4782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-426-1928
Provider Business Practice Location Address Fax Number:
520-426-9088
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KAZI
Authorized Official First Name:
NADEEM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-426-1928

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  25728 , 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: AZ0810620 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 628670 . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PIM21KAZINA1 . This is a "MERCYCAREPLAN PREMIUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1Z0212 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 393968 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95964 . This is a "PACIFICARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 601101 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95999 . This is a "PACIFICARE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1002828 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7612839 . This is a "DIVISION OF MEDICAL ASST" identifier . This identifiers is of the category "OTHER".




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