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  7. NPI Record 1043989726

WESTERN MED GROUP LLC
Complete NPI Record 1043989726
Pain Medicine - Interventional Pain Medicine in Anthem, AZ

NPI Status: Active since September 07, 2021

Contact Information

3624 W ANTHEM WAY STE C108
ANTHEM, AZ
ZIP 85086
Phone: (602) 441-3573

Get Directions

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 Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Healthcare Provider Taxonomy Code 2
  26. Healthcare Provider Primary Taxonomy Switch 2
  27. Healthcare Provider Taxonomy Code 3
  28. Healthcare Provider Primary Taxonomy Switch 3
  29. Healthcare Provider Taxonomy Code 4
  30. Healthcare Provider Primary Taxonomy Switch 4
  31. Healthcare Provider Taxonomy Code 5
  32. Healthcare Provider Primary Taxonomy Switch 5
  33. Is Organization Subpart
  34. Parent Organization LBN
  35. Parent Organization TIN
  36. Authorized Official Name Prefix Text
  37. Authorized Official Credential Text
  38. Healthcare Provider Taxonomy Group 1
  39. Healthcare Provider Taxonomy Group 2
  40. Healthcare Provider Taxonomy Group 4
  41. Healthcare Provider Taxonomy Group 5
  42. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1043989726. 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: 1043989726
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: 21001 N TATUM BLVD STE 1630-606
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 Business Mailing Address City Name: PHOENIX
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: 850504242
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: 6023545310
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 First Line Business Practice Location Address: 3624 W ANTHEM WAY STE C108
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 Business Practice Location Address City Name: ANTHEM
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: 850860457
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: 6024413573
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 9/7/2021
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/24/2022
The date that a record was last updated or changed.
Authorized Official Last Name: MOSHIRI
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: THOMAS
The first name of the authorized official.
Authorized Official Title or Position: MANAGER
The title or position of the authorized official.
Authorized Official Telephone Number: 6024413573
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 111N00000X
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.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 208100000X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 332B00000X
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 363L00000X
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 208VP0014X
Healthcare Provider Primary Taxonomy Switch 5: Y
Is Organization Subpart: Y
Parent Organization LBN: WESTERN MED GROUP LLC
Parent Organization TIN: UNAVAIL
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: MD
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 2/24/2022