1407026644 NPI number — ARIZONA HEALTH CARE CONTRACT MANAGEMENT SERVICES INC.

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 1407026644 NPI number — ARIZONA HEALTH CARE CONTRACT MANAGEMENT SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA HEALTH CARE CONTRACT MANAGEMENT SERVICES 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:
SIX PINES
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:
1407026644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3838 N CENTRAL AVE STE 1200
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:
85012-1997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-646-6175
Provider Business Mailing Address Fax Number:
617-790-4271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3838 N CENTRAL AVE STE 1200
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:
85012-1997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-646-6175
Provider Business Practice Location Address Fax Number:
617-790-4271
Provider Enumeration Date:
03/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
IAN
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
800-388-5150

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  BH-1770 , 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: 109844 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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