1811360365 NPI number — CITY OF SAN LUIS ARIZONA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811360365 NPI number — CITY OF SAN LUIS ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SAN LUIS ARIZONA
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:
1811360365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7740
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LUIS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85349-6816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-341-8542
Provider Business Mailing Address Fax Number:
928-341-8549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1165 NORTH MCCAIN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85349-0445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-341-8550
Provider Business Practice Location Address Fax Number:
928-627-1426
Provider Enumeration Date:
11/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CASTRO
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
928-341-8542

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  142 , 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: 142 . This is a "CERTIFICATE OF NECESSITY" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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