1063725117 NPI number — LCS-WESTMINSTER PARTNERSHIP IV LLP

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 1063725117 NPI number — LCS-WESTMINSTER PARTNERSHIP IV LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LCS-WESTMINSTER PARTNERSHIP IV LLP
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:
SAGEWOOD/ACACIA HEALTH CENTER AT SAGEWOOD
Provider Other Organization Name Type Code:
3
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:
1063725117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4555 E MAYO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85050-6952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-384-5800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4555 E MAYO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85050-6952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-384-5800
Provider Business Practice Location Address Fax Number:
480-384-5670
Provider Enumeration Date:
07/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MERCURIS PENDROY
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
D
Authorized Official Title or Position:
SENIOR VICE PRESIDENT OF MGR MBR
Authorized Official Telephone Number:
515-875-4527

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com