NPIMap

Organization Active NPI

Portable Practical Education Preparation Inc.

  • Multi-Specialty Clinic/Center
  • Ajo, AZ
National Provider Identifier
1215034590
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
BH387 Issued in AZ
Legal business name
PORTABLE PRACTICAL EDUCATION PREPARATION INC.
Practice address
111 La Mina Ave
Room 5
Ajo, AZ 85321-2716
Phone
(520) 387-5232
Fax
(520) 387-5732
NPI assigned
Sep 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. John David Arnold, PH.D
Title
Ceo/Founder
Phone
(520) 622-3553

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X BH387 AZ Primary

Addresses

Primary practice location

111 La Mina Ave
Room 5
Ajo, AZ 85321-2716

Mailing address

802 E 46TH St
Tucson, AZ 85713-5006
Phone (520) 622-3553

Other identifiers 1

IdentifierTypeStateIssuer
134966MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Portable Prac Ed Prep Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

111 W La Mina Ave
Rm 5
Ajo, AZ 85321
Phone (520) 387-5232

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215034590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 E 46TH ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857135006",
            "telephone_number": "520-622-3553",
            "fax_number": "520-622-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LA MINA AVE",
            "address_2": "ROOM 5",
            "city": "AJO",
            "state": "AZ",
            "postal_code": "853212716",
            "telephone_number": "520-387-5232",
            "fax_number": "520-387-5732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTABLE PRACTICAL EDUCATION PREPARATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ARNOLD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "520-622-3553",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AZ",
            "license": "BH387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134966",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ajo, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.