1871551903 NPI number — NEB GROUP OF ARIZONA LLC

Table of content: (NPI 1871551903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871551903 NPI number — NEB GROUP OF ARIZONA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEB GROUP OF ARIZONA 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:
1871551903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8711 E. PINNACLE PEAK RD. PMB
Provider Second Line Business Mailing Address:
PMB 327
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-595-7272
Provider Business Mailing Address Fax Number:
480-595-7273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8261 E. EVANS RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-595-7272
Provider Business Practice Location Address Fax Number:
480-595-7273
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEENE
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-595-7272

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 917685 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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