1871630798 NPI number — AJO UNIFIED SCHOOL DISTRICT #15

Table of content: (NPI 1871630798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871630798 NPI number — AJO UNIFIED SCHOOL DISTRICT #15

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AJO UNIFIED SCHOOL DISTRICT #15
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:
1871630798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 N WELL RD
Provider Second Line Business Mailing Address:
P.O. BOX 68
Provider Business Mailing Address City Name:
AJO
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85321-1840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-387-5618
Provider Business Mailing Address Fax Number:
520-387-6545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N WELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AJO
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85321-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-387-5618
Provider Business Practice Location Address Fax Number:
520-387-6545
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
CLAUDIAN
Authorized Official Title or Position:
MEDICAID BILLING CLERK
Authorized Official Telephone Number:
520-387-5619

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 868838 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com