Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261QU0200X | Clinic/Center | Urgent Care | | | No |
| 2 | 282N00000X | General Acute Care Hospital | | H0077 | ARIZONA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 860117301 | OTHER | ARIZONA | AZ DEPT OF JUVENILLE CORR |
| 2 | 860117301 | OTHER | ARIZONA | HEALTH MGMT NETWORK |
| 3 | 860117301 | OTHER | ARIZONA | BEECH STREET |
| 4 | 860117301 | OTHER | ARIZONA | DONOR NETWORK OF AZ |
| 5 | 860117301 | OTHER | ARIZONA | ACCOUNTABLE HEALTH PLANS |
| 6 | 0676381 | OTHER | ARIZONA | AETNA HEALTH INC. |
| 7 | 446246 | MEDICAID | ARIZONA | |
| 8 | 860117301 | OTHER | ARIZONA | AZ FOUNDATION FOR MED CAR |
| 9 | 860117301 | OTHER | ARIZONA | CITY OF GLENDALE WORKERS |
| 10 | 860117301 | OTHER | ARIZONA | AZ STATE PHYS ASSOC |
| 11 | 860117301 | OTHER | ARIZONA | COMMUNITY CARE NETWORK |
| 12 | 020181 | MEDICAID | ARIZONA | |
| 13 | BS00702 | OTHER | ARIZONA | UNITED WEST LABS |
| 14 | 0000 | OTHER | ARIZONA | BLUE CROSS TRICARE |
| 15 | 860117301 | OTHER | ARIZONA | FEDERAL CORRECTIONAL INST |
| 16 | 860117301 | OTHER | ARIZONA | FIRST HEALTH |
| 17 | 860117301 | OTHER | ARIZONA | CHOICE CARE NETWORK |
| 18 | AZ0204830 | OTHER | ARIZONA | BLUE CROSS |
