=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477994861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW THOMAS YOUNG RRT-NPS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2013
-----------------------------------------------------
Last Update Date | 07/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N US HIGHWAY 89
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86313-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-445-4860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 N US HIGHWAY 89
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86313-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2279P3900X
-----------------------------------------------------
Taxonomy Name | Neonatal/Pediatric Registered Respiratory Therapist
-----------------------------------------------------
License Number | 194.007249
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2279P3900X
-----------------------------------------------------
Taxonomy Name | Neonatal/Pediatric Registered Respiratory Therapist
-----------------------------------------------------
License Number | 010751
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2279P3900X
-----------------------------------------------------
Taxonomy Name | Neonatal/Pediatric Registered Respiratory Therapist
-----------------------------------------------------
License Number | RT12357
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------