1649417817 NPI number — T-BIRD FAMILY & INDUSTRIAL PHYSICIANS, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649417817 NPI number — T-BIRD FAMILY & INDUSTRIAL PHYSICIANS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T-BIRD FAMILY & INDUSTRIAL PHYSICIANS, P.C.
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:
1649417817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14045 N. 7TH ST.
Provider Second Line Business Mailing Address:
SUITE #1
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85022-4387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-866-0961
Provider Business Mailing Address Fax Number:
602-866-9820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14045 N 7TH ST
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85022-4388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-866-0961
Provider Business Practice Location Address Fax Number:
602-866-9820
Provider Enumeration Date:
01/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ENGLE
Authorized Official First Name:
PEGI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
602-866-0961

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2019 , 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)





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