1649380205 NPI number — WEST PHOENIX PEDIATRICS PLC

Table of content: (NPI 1649380205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649380205 NPI number — WEST PHOENIX PEDIATRICS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST PHOENIX PEDIATRICS PLC
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:
1649380205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9305 W THOMAS RD
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-889-6186
Provider Business Mailing Address Fax Number:
623-889-6188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9305 W THOMAS RD
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-889-6186
Provider Business Practice Location Address Fax Number:
623-889-6188
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RANGEL
Authorized Official First Name:
CELIDA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
623-889-6186

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  34213 , 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: 2Z3015 . This is a "HEALTHNET PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2Z3015 . This is a "HEALTHNET POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ078820 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5655373 . This is a "MERCY CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 46677 . This is a "BANNER CHOICE PLUS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5655373 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ0788280 . This is a "CIGNA HELATHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145458 . This is a "GALAXY HEALTH NTWK" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ078820 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7672735 . This is a "AETNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 959223 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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