1548261712 NPI number — NEUROMEDICINE CENTER, PLLC

Table of content: (NPI 1548261712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548261712 NPI number — NEUROMEDICINE CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROMEDICINE CENTER, PLLC
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:
1548261712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 S DOBSON RD
Provider Second Line Business Mailing Address:
SUITE 213A
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85202-4725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-615-7800
Provider Business Mailing Address Fax Number:
480-615-7803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 S DOBSON RD
Provider Second Line Business Practice Location Address:
SUITE 213A
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85202-4725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-615-7800
Provider Business Practice Location Address Fax Number:
480-615-7803
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
JAYANTIBHAI
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
480-615-7800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  28930 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 30177 , 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: AZ0713850 . This is a "ASHOK NARAYAN, MD (BCBS)" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z0871 . This is a "JP-HEALTHNET PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5085187 . This is a "JP--AETNA PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 691883 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1Z0888 . This is a "AN-HEALTHNET PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7550417 . This is a "AN--AETNA PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 557803 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0881440 . This is a "JAYANTIBHAI PATEL, MD (BC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com