1932581766 NPI number — 6730 W CAMELBACK ROAD LLC DBA INSTANTMED HEALTH CENTER

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 1932581766 NPI number — 6730 W CAMELBACK ROAD LLC DBA INSTANTMED HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
6730 W CAMELBACK ROAD LLC DBA INSTANTMED HEALTH CENTER
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:
1932581766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5104 N 67TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-899-4404
Provider Business Mailing Address Fax Number:
602-899-4408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5104 N 67TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-899-4404
Provider Business Practice Location Address Fax Number:
602-899-4408
Provider Enumeration Date:
06/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SIDDARAMU
Authorized Official First Name:
RAJIV
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
602-899-4404

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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