1790016244 NPI number — APACHE JUNCTION HOSPITAL, LLC

Table of content: (NPI 1790016244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790016244 NPI number — APACHE JUNCTION HOSPITAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APACHE JUNCTION HOSPITAL, 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:
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:
1790016244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 52163
Provider Second Line Business Mailing Address:
MSC # 170
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85072-2163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-898-3333
Provider Business Mailing Address Fax Number:
480-223-4236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 W SOUTHERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APACHE JUNCTION
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85120-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-237-3200
Provider Business Practice Location Address Fax Number:
480-237-3206
Provider Enumeration Date:
01/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CRABTREE
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
480-898-3333

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , 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: 500470 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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