1689867517 NPI number — SANSON PEDIATRICS, P.C.

Table of content: (NPI 1689867517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689867517 NPI number — SANSON PEDIATRICS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANSON PEDIATRICS, 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:
1689867517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 S CANDY LN
Provider Second Line Business Mailing Address:
SUITE 6B
Provider Business Mailing Address City Name:
COTTONWOOD
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86326-4120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-649-1559
Provider Business Mailing Address Fax Number:
928-649-1427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 S CANDY LN
Provider Second Line Business Practice Location Address:
SUITE 6B
Provider Business Practice Location Address City Name:
COTTONWOOD
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86326-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-649-1559
Provider Business Practice Location Address Fax Number:
928-649-1427
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANSON-JARACZEWSKI
Authorized Official First Name:
JAYNE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
928-649-1559

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  30834 , 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: 728454002 . This is a "APIPA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 728454 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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