1982952024 NPI number — URBAN LIVESTOCK & EQUINE VETERINARY SERVICES

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 1982952024 NPI number — URBAN LIVESTOCK & EQUINE VETERINARY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URBAN LIVESTOCK & EQUINE VETERINARY SERVICES
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:
1982952024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
744 N CENTER ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85201-5084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-436-4970
Provider Business Mailing Address Fax Number:
480-284-5045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
744 N CENTER ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85201-5084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-436-4970
Provider Business Practice Location Address Fax Number:
480-284-5045
Provider Enumeration Date:
08/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
COLLEEN
Authorized Official Middle Name:
SHANNON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-436-4970

Provider Taxonomy Codes

  • Taxonomy code: 174M00000X , with the licence number:  6252 , 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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