Provider Demographics
NPI:1902361223
Name:AKOS LIVE
Entity Type:Organization
Organization Name:AKOS LIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED SPEC
Authorized Official - Prefix:
Authorized Official - First Name:DESERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TSOSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-935-6389
Mailing Address - Street 1:PO BOX 41638
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1638
Mailing Address - Country:US
Mailing Address - Phone:602-935-6389
Mailing Address - Fax:
Practice Address - Street 1:1637 N TREKELL RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2740
Practice Address - Country:US
Practice Address - Phone:602-899-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty