Provider Demographics
NPI:1184973018
Name:NCA HOLDINGS OF ARIZONA, LLC
Entity type:Organization
Organization Name:NCA HOLDINGS OF ARIZONA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:13090 N 94TH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4256
Practice Address - Country:US
Practice Address - Phone:623-977-2707
Practice Address - Fax:623-977-2331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROPATHY CENTERS OF AMERICA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-06
Last Update Date:2013-12-27
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
AZ6718740001Medicare NSC
AZZ91727Medicare PIN