1902125206 NPI number — JON AMYX HAD

Table of content: JON AMYX HAD (NPI 1902125206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902125206 NPI number — JON AMYX HAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMYX
Provider First Name:
JON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HAD
Provider Gender Code:
M

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:
1902125206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8800 SE SUNNYSIDE RD
Provider Second Line Business Mailing Address:
STE 300-N
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015-5738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-659-5115
Provider Business Mailing Address Fax Number:
503-659-5887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 THE CITY DR S
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-4940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-776-4366
Provider Business Practice Location Address Fax Number:
714-776-0899
Provider Enumeration Date:
05/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  HA 3433 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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