1659513760 NPI number — DR. JOHN R. MARKHAM PC

Table of content: (NPI 1659513760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659513760 NPI number — DR. JOHN R. MARKHAM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JOHN R. MARKHAM PC
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:
6
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:
1659513760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1680 WILLOW CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86301-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-778-3950
Provider Business Mailing Address Fax Number:
928-778-3999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 W YAVAPAI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICKENBURG
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85390-3280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-684-2880
Provider Business Practice Location Address Fax Number:
928-684-3209
Provider Enumeration Date:
04/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
928-778-3950

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  4498 , 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: 2Z6546 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: NNP12599 . This is a "UNIVERSAL HEALTH CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 033176-001 . This is a "MERCYCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 190721 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 190721 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3421045 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 572818 . This is a "RAN-AMN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ01170 . This is a "MEDICARE SUBMITTER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7742967 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 866291-9714 . This is a "HUMANA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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