1790971307 NPI number — ARIZONA SINUS AND ENT ASSOCIATES PC

Table of content: (NPI 1790971307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790971307 NPI number — ARIZONA SINUS AND ENT ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA SINUS AND ENT ASSOCIATES PC
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:
1790971307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14687
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85267-4687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-258-9859
Provider Business Mailing Address Fax Number:
602-256-0820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 N 9TH STREET B
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:
85006-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-258-9859
Provider Business Practice Location Address Fax Number:
602-256-0820
Provider Enumeration Date:
09/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REHL
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
602-258-9859

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DG8404 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 302627 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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