1003178229 NPI number — MARICOPA INTEGRATED HEALTH SYSTEM

Table of content: MR. EANG B. KEO RPH (NPI 1659661429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003178229 NPI number — MARICOPA INTEGRATED HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARICOPA INTEGRATED HEALTH SYSTEM
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:
1003178229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5110 N 32ND ST
Provider Second Line Business Mailing Address:
312
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85018-1451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-801-8491
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 E ROOSEVELT ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF MEDICINE
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85008-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-344-5366
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ZEHENTBAUER
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROJECT MANAGER
Authorized Official Telephone Number:
602-344-8435

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  RN038285 , 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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