1821415902 NPI number — MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

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 1821415902 NPI number — MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
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:
1821415902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85038-9670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-344-8178
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8088 W WHITNEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85345-6564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-855-9973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FOWLER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SYSTEM DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
602-344-2830

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  H3673 , 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: 987495 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0947 . This is a "HEALTHNET OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 29517 . This is a "PHOENIX INDIAN MEDICAL CENTER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 500005 . This is a "EVERCARE CHOICE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 631935 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0205850 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 189350800 . This is a "UD DEPT OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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