1619954914 NPI number — TOWN OF GILA BEND

Table of content: (NPI 1619954914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619954914 NPI number — TOWN OF GILA BEND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF GILA BEND
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:
6
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:
1619954914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILA BEND
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85337-0019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-683-2255
Provider Business Mailing Address Fax Number:
928-683-6430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
644 W PIMA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILA BEND
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-683-2255
Provider Business Practice Location Address Fax Number:
928-683-6430
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
ARELIA
Authorized Official Middle Name:
I
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
602-909-3644

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  78 , 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: 071978 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590014287 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0152460 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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