1669426235 NPI number — PRESIDIO SURGICAL GROUP, P.C.

Table of content: RICHELE LYNN THOMPSON CNP (NPI 1063569481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669426235 NPI number — PRESIDIO SURGICAL GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESIDIO SURGICAL GROUP, 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:
1669426235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 W ORANGE GROVE RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85704-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-219-9125
Provider Business Mailing Address Fax Number:
520-219-9130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 W ORANGE GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85704-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-219-9125
Provider Business Practice Location Address Fax Number:
520-219-9130
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARNAHAN
Authorized Official First Name:
WILLARD
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-219-9125

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  13209 , 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)





Copyright © 2007-2026 www.npivalidator.com