1750450532 NPI number — AMERICAN INDIAN PREVENTION COALITION

Table of content: (NPI 1750450532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750450532 NPI number — AMERICAN INDIAN PREVENTION COALITION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN INDIAN PREVENTION COALITION
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:
6
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:
1750450532
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:
PO BOX 25047
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:
85002-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-424-1600
Provider Business Mailing Address Fax Number:
602-532-7202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2302 N 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85006-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-424-1600
Provider Business Practice Location Address Fax Number:
602-532-7202
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEACH
Authorized Official First Name:
BONNY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
602-432-3098

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103T00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3245S0500X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 118168 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 777237 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 803925 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 790255 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 743733 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189011 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 864729 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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