1891907747 NPI number — ARIZONA VASCULAR MEDICAL EQUIPMENT INC.

Table of content: (NPI 1891907747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891907747 NPI number — ARIZONA VASCULAR MEDICAL EQUIPMENT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA VASCULAR MEDICAL EQUIPMENT INC.
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:
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:
1891907747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 E SOUTHERN AVE
Provider Second Line Business Mailing Address:
SUITE F2
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85282-7626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-854-1900
Provider Business Mailing Address Fax Number:
480-854-1088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5432 E SOUTHERN AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-2772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-854-1900
Provider Business Practice Location Address Fax Number:
480-854-1088
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRANILLO
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
ERNESTINA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-854-1900

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  07-631470-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: AZ0275360 . This is a "AZ BC/BS ID #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ401480 . This is a "PACIFICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 82-80095 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 325036 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AX4016 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 241407700 . This is a "DEPT. OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0005429096 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0275360 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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