1841237294 NPI number — KAREN ALYCE COLEMAN PA-C

Table of content: CHOON WHA CHUN M.D. (NPI 1619954831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841237294 NPI number — KAREN ALYCE COLEMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
KAREN
Provider Middle Name:
ALYCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIEFFER
Provider Other First Name:
KAREN
Provider Other Middle Name:
ALYCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841237294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2946 E. BANNER GATEWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-256-6444
Provider Business Mailing Address Fax Number:
480-256-3682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2946 E. BANNER GATEWAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-406-4000
Provider Business Practice Location Address Fax Number:
602-406-6498
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  3133 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 3133 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 3133 , 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: 5550830003 . This is a "MEDICARE NSC PEORIA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830006 . This is a "MEDICARE NSC ANTHEM" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830008 . This is a "MEDICARE NSC SWV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830010 . This is a "MEDICARE NSC GILBERT" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830004 . This is a "MEDICARE NSC PV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830009 . This is a "MEDICARE NSC AZ NORTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 906480 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00214608 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830007 . This is a "MEDICARE NSC DV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830001 . This is a "MEDICARE NSC SCW" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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