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  7. NPI Record 1013465863

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Complete NPI Record 1013465863
Clinic/Center - Medical Specialty in Glendale, AZ

NPI Status: Active since September 21, 2016

Contact Information

4344 W BELL RD
SUITE 102
GLENDALE, AZ
ZIP 85308
Phone: (602) 595-3341
Fax: (602) 535-1142

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Second Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Second Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Middle Name
  26. Authorized Official Title or Position
  27. Authorized Official Telephone Number
  28. Healthcare Provider Taxonomy Code 1
  29. Provider License Number 1
  30. Provider License Number State Code 1
  31. Healthcare Provider Primary Taxonomy Switch 1
  32. Other Provider Identifier 1
  33. Other Provider Identifier Type Code 1
  34. Other Provider Identifier State 1
  35. Other Provider Identifier Issuer 1
  36. Is Organization Subpart
  37. Authorized Official Name Prefix Text
  38. Authorized Official Credential Text

Complete NPI Dataset

This page represents the complete record for NPI 1013465863. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1013465863
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 4344 WEST BELL ROAD
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 102
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: GLENDALE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: AZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 853083589
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 6025953341
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 6025951142
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 4344 W BELL RD
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 Second Line Business Practice Location Address: SUITE 102
The second 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 Business Practice Location Address City Name: GLENDALE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: AZ
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 853083589
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 Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 6025953341
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 6025351142
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 9/21/2016
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 12/6/2016
The date that a record was last updated or changed.
Authorized Official Last Name: GESHEL
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: RICHARD
The first name of the authorized official.
Authorized Official Middle Name: JOSEPH
The middle name of the authorized official.
Authorized Official Title or Position: PHYSICIAN / PRESIDENT
The title or position of the authorized official.
Authorized Official Telephone Number: 6025953341
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QM2500X
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 1: 4517
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’’.
Provider License Number State Code 1: AZ
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.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: Z153122
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: AZ
Other Provider Identifier Issuer 1: MEDICARE PTAN
Is Organization Subpart: N
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: DO