1811360365 NPI number — CITY OF SAN LUIS ARIZONA

Table of content: (NPI 1811360365)

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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