1639134273 NPI number — CAROL SUE HESS PT

Table of content: CAROL SUE HESS PT (NPI 1639134273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639134273 NPI number — CAROL SUE HESS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HESS
Provider First Name:
CAROL
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAAKENSON
Provider Other First Name:
CAROL
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639134273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2024
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTONWOOD
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86326-2024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-639-3068
Provider Business Mailing Address Fax Number:
928-639-3346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 W MINGUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COTTONWOOD
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86326-4088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-639-3068
Provider Business Practice Location Address Fax Number:
928-639-3346
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 8079 , 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: 338486 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5742HA . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 650021418 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8336380 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8928851 . This is a "L&I CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911745305-98208-A002 . This is a "TRICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0144100 . This is a "DEPT. OF LABOR & INDUS." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4412893 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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