1629105705 NPI number — CASA DE LOS NINOS

Table of content: DR. PHILIP A. PILGRAM M.D. (NPI 1124083506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629105705 NPI number — CASA DE LOS NINOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASA DE LOS NINOS
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:
1629105705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 N 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85705-7467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-624-5600
Provider Business Mailing Address Fax Number:
520-623-2443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 N 4TH AVE
Provider Second Line Business Practice Location Address:
1138 N. 5TH AVE.
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85705-7467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-624-5600
Provider Business Practice Location Address Fax Number:
520-623-2443
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAUSLER
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CHILD AND FAMILY RESOUR
Authorized Official Telephone Number:
520-624-5600

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  UNC-1216 , 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: 07ADHS0189-1 . This is a "COMMUNITY SERVICES PROVI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 074928 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 385189 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 055780 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: UNC-1216 . This is a "ADHS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com