1720230824 NPI number — MAMMOGRAPHY PARTNERS LLC

Table of content: (NPI 1720230824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720230824 NPI number — MAMMOGRAPHY PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAMMOGRAPHY PARTNERS LLC
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:
1720230824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8401 JACK FINNEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75402-3017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-945-2455
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2840 W INA RD
Provider Second Line Business Practice Location Address:
#144
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85741-2587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-546-5599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KANEWSKE
Authorized Official First Name:
EILEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR. PT. ACCT.
Authorized Official Telephone Number:
469-398-4114

Provider Taxonomy Codes

  • Taxonomy code: 261QR0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 391935 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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