NPI |
1538554977 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Entity Type Code |
1 |
Other name by which the organization provider is or has been known. |
Provider Last Name Legal Name |
FITZPATRICK-RODGERS |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Name |
COLLEEN |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Name Prefix Text |
MS. |
The city name in the location address of the provider being identified. |
Provider Credential Text |
LISAC |
The State code in the location of the provider
being identified. |
Provider First Line Business Practice Location Address |
1901 N TREKELL RD |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address City Name |
CASA GRANDE |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
AZ |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
851221770 |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Telephone Number |
5208361029 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
5208366733 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
4/2/2015 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
4/2/2015 |
The middle name of the authorized official. |
Provider Gender Code |
F |
The title or position of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
101YA0400X |
The 10-position telephone number of the authorized official. |
Provider License Number 1 |
LISAC-1402 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number State Code 1 |
AZ |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Is Sole Proprietor |
N |
|