1891073011 NPI number — PALO VERDE HEMATOLOGY ONCOLOGY, LTD

Table of content: (NPI 1891073011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891073011 NPI number — PALO VERDE HEMATOLOGY ONCOLOGY, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALO VERDE HEMATOLOGY ONCOLOGY, LTD
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:
PALO VERDE CANCER SPECIALISTS
Provider Other Organization Name Type Code:
3
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:
1891073011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5601 W EUGIE AVE
Provider Second Line Business Mailing Address:
#106
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85304-1255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-978-6255
Provider Business Mailing Address Fax Number:
602-644-3661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9250 W. THOMAS RD.
Provider Second Line Business Practice Location Address:
#150
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-978-6255
Provider Business Practice Location Address Fax Number:
623-478-8423
Provider Enumeration Date:
07/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ZAFAR
Authorized Official First Name:
HAIDER
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/SHAREHOLDER
Authorized Official Telephone Number:
602-978-6255

Provider Taxonomy Codes

  • Taxonomy code: 1835X0200X , with the licence number:  14106 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 24284 , 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)





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