1790069870 NPI number — BNR CORPORATION

Table of content: DOROTHY L COBB PT (NPI 1225016181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790069870 NPI number — BNR CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BNR CORPORATION
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:
1790069870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 S 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTONWOOD
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86326-5440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-639-3860
Provider Business Mailing Address Fax Number:
928-649-0410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 S 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COTTONWOOD
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86326-5440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-639-3860
Provider Business Practice Location Address Fax Number:
928-649-0410
Provider Enumeration Date:
10/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DONAHUE
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
FACILITY MANAGER
Authorized Official Telephone Number:
928-639-3860

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL5008C , 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: 262760 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com