1578965059 NPI number — AZ HEALTH PATH, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578965059 NPI number — AZ HEALTH PATH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AZ HEALTH PATH, INC
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:
1578965059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8111 E THOMAS RD STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251-5876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-735-9090
Provider Business Mailing Address Fax Number:
480-584-4885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8111 E THOMAS RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-5876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-735-9090
Provider Business Practice Location Address Fax Number:
480-584-4885
Provider Enumeration Date:
09/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RHODES
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
480-735-9090

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC10276 , 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: 750001 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135692471 . This is a "INDIVIDUAL NPI FOR DR. RACHEL RHODES" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7108598 . This is a "MEDICARE UPIN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 467766 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033670302 . This is a "INDIVIDUAL NPI FOR ERIK EIDENSCHINK" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1851484836 . This is a "INDIVIDUAL NPI FOR MADISON RHODES" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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