NPIMap

Organization Active NPI

Sos Phoenix LLC

  • Behavior Analyst
  • Mesa, AZ
National Provider Identifier
1194435149
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
SOS PHOENIX LLC
Practice address
1303 S Longmore Ste 2
Mesa, AZ 85202-9607
Phone
(801) 635-6208
NPI assigned
Nov 30, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ted Holmgren
Title
Owner, General Manager
Phone
(801) 635-6208

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary
Hearing and Speech Clinic/Center 261QH0700X
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

1303 S Longmore Ste 2
Mesa, AZ 85202-9607

Mailing address

5018 E Hannibal St
Mesa, AZ 85205-6879
Phone (801) 635-6208

Other names 1

  • Success on the Spectrum Doing business as

National Provider Directory

National Provider Directory

Locations

1303 S Longmore
Ste 2
Mesa, AZ 85202
Phone (480) 712-5181

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669766400000",
    "number": "1194435149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5018 E HANNIBAL ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852056879",
            "telephone_number": "801-635-6208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 S LONGMORE STE 2",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852029607",
            "telephone_number": "801-635-6208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOS PHOENIX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-30",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A",
        "authorized_official_last_name": "HOLMGREN",
        "authorized_official_first_name": "TED",
        "authorized_official_title_or_position": "OWNER, GENERAL MANAGER",
        "authorized_official_telephone_number": "801-635-6208",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Success on the Spectrum",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.