1649339615 NPI number — ARIZONA DESERT ORTHOPAEDIC CENTER, INC.

Table of content: (NPI 1649339615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649339615 NPI number — ARIZONA DESERT ORTHOPAEDIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA DESERT ORTHOPAEDIC CENTER, 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:
1649339615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13660 N 94TH DR
Provider Second Line Business Mailing Address:
SUITE C1
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85381-4836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-974-6542
Provider Business Mailing Address Fax Number:
623-321-1215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13660 N 94TH DR
Provider Second Line Business Practice Location Address:
SUITE C1
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-4836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-974-6542
Provider Business Practice Location Address Fax Number:
623-321-1215
Provider Enumeration Date:
12/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAMM
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
623-974-6542

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  CPO 0057 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1649339615 . This is a "BLUE CROSS & BLUE SHIELD OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z7000 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3231829 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".