1720278047 NPI number — ARIZONA INSTITUTE OF EYE SURGERY LLC

Table of content: (NPI 1720278047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720278047 NPI number — ARIZONA INSTITUTE OF EYE SURGERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA INSTITUTE OF EYE SURGERY 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:
PRESCOTT VISION & EYE SURGERY CENTER
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:
1720278047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 S ROCKFORD DR #220
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:
85281-4963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-598-7488
Provider Business Mailing Address Fax Number:
602-231-6215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3192 WILLOW CREEK RD
Provider Second Line Business Practice Location Address:
3192 WILLOW CREEK ROAD
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86301-6610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-778-3950
Provider Business Practice Location Address Fax Number:
928-778-3999
Provider Enumeration Date:
08/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROOKFIELD
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
602-598-7488

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4498 . This is a "PHYSICIAN STATE LICENSE N" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: IZ0354 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: NNP12601 . This is a "UNIVERSAL HEALTH CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: OSC-4258 . This is a "SURGERY CENTER LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1720278047 . This is a "BLUE CROSS/BLUE SHIELD OF AZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 572818 . This is a "RAN & AMN" identifier . This identifiers is of the category "OTHER".
  • Identifier: DM6XBU . This is a "ARIZONA FOUNDATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03-C0001215 . This is a "MEDICARE CCN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 280244 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 280244 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".