Provider Demographics
NPI:1427362003
Name:ONIPAA LLC
Entity Type:Organization
Organization Name:ONIPAA LLC
Other - Org Name:BMS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:RYER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-252-1716
Mailing Address - Street 1:1002 E PALM LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2141
Mailing Address - Country:US
Mailing Address - Phone:602-252-1716
Mailing Address - Fax:602-419-2116
Practice Address - Street 1:1002 E PALM LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2141
Practice Address - Country:US
Practice Address - Phone:602-252-1716
Practice Address - Fax:602-419-2116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONIPAA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-05
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1997261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ656264Medicaid
AZ656264Medicaid