1972936946 NPI number — PINAL COUNTY ARIZONA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972936946 NPI number — PINAL COUNTY ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINAL COUNTY ARIZONA
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:
1972936946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2945
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85132-3055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-866-7319
Provider Business Mailing Address Fax Number:
520-866-7066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41600 W SMITH ENKE RD
Provider Second Line Business Practice Location Address:
BUILDING 15
Provider Business Practice Location Address City Name:
MARICOPA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85138-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-866-7319
Provider Business Practice Location Address Fax Number:
520-866-7066
Provider Enumeration Date:
08/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ESCALANTE
Authorized Official First Name:
SUSIE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ACCOUNT CLERK-BILLING
Authorized Official Telephone Number:
520-866-7319

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  OTC5314 , 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: 155847 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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