Provider Demographics
NPI:1013975929
Name:TEAM O'NEILL INC
Entity type:Organization
Organization Name:TEAM O'NEILL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:623-875-6683
Mailing Address - Street 1:10336 W COGGINS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3438
Mailing Address - Country:US
Mailing Address - Phone:623-875-6683
Mailing Address - Fax:623-875-9472
Practice Address - Street 1:10336 W COGGINS DR
Practice Address - Street 2:SUITE B
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3438
Practice Address - Country:US
Practice Address - Phone:623-875-6683
Practice Address - Fax:623-875-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07660280R335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4660780001Medicare ID - Type UnspecifiedPROVIDER ID NUMBER