Provider Demographics
NPI:1952644478
Name:NCA HOLDINGS OF ARIZONA LLC
Entity Type:Organization
Organization Name:NCA HOLDINGS OF ARIZONA LLC
Other - Org Name:NEW PROMISE NEUROPATHY CARE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-602-2626
Mailing Address - Street 1:7558 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 1-496
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N GILBERT RD
Practice Address - Street 2:SUITE I
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2328
Practice Address - Country:US
Practice Address - Phone:480-539-2808
Practice Address - Fax:480-539-2795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROPATHY CENTERS OF AMERICA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-03
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ204D00000X, 207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ746289Medicaid
AZZ91727Medicare PIN
AZ6718740002Medicare NSC