1841463635 NPI number — AKEA ENTERPRISE LLC

Table of content: (NPI 1841463635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841463635 NPI number — AKEA ENTERPRISE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AKEA ENTERPRISE LLC
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:
1841463635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3641 N CAMPBELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85719-1534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-323-7400
Provider Business Mailing Address Fax Number:
520-323-7800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3641 N CAMPBELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85719-1534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-323-7400
Provider Business Practice Location Address Fax Number:
520-323-7800
Provider Enumeration Date:
04/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MULKEY
Authorized Official First Name:
ABE
Authorized Official Middle Name:
NERNELL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
520-323-7400

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  07-618360-B , 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: D08606268 . This is a "CMS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 4494730001 . This is a "NSC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".