1679020028 NPI number — AETNA HEALTH INC.

Table of content: (NPI 1679020028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679020028 NPI number — AETNA HEALTH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AETNA HEALTH 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:
AETNA BETTER HEALTH OF MARYLAND
Provider Other Organization Name Type Code:
3
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:
1679020028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 E COTTON CENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85040-8840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-659-1100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 UNION MEETING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE BELL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19422-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-702-3862
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BRUBAKER
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR, PRINCIPAL OFF. -PRESIDENT
Authorized Official Telephone Number:
602-659-1160

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com