1972839108 NPI number — TRAX INTERNATIONAL INC

Table of content: (NPI 1972839108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972839108 NPI number — TRAX INTERNATIONAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRAX INTERNATIONAL 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:
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:
1972839108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 N VIA DE CORDOBA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85749-9116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-906-5444
Provider Business Mailing Address Fax Number:
520-760-0043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6627 S TUCSON BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85756-7011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-807-5800
Provider Business Practice Location Address Fax Number:
520-807-5801
Provider Enumeration Date:
10/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
JANETTE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
520-906-5444

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  881377 , 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: 881377 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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