Provider Demographics
NPI:1962689489
Name:DAN BANGART PLC
Entity Type:Organization
Organization Name:DAN BANGART PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-974-0522
Mailing Address - Street 1:13660 N 94TH DRIVE
Mailing Address - Street 2:SUITE F-1
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4323
Mailing Address - Country:US
Mailing Address - Phone:623-974-0522
Mailing Address - Fax:
Practice Address - Street 1:13660 N 94TH DRIVE
Practice Address - Street 2:SUITE F-1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4323
Practice Address - Country:US
Practice Address - Phone:623-974-0522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0345213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
480026137OtherMEDICARE RAILROAD
AZ186206OtherAHCCCS
AZAZ0190790OtherBCBS
U12172Medicare UPIN
AZ186206OtherAHCCCS
ZDPM345Medicare PIN
0804690002Medicare NSC