1578608535 NPI number — ARIZONA COMMUNITY PHYSICIANS PC

Table of content: (NPI 1578608535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578608535 NPI number — ARIZONA COMMUNITY PHYSICIANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA COMMUNITY PHYSICIANS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACP LABORATORY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578608535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5055 E BROADWAY BLVD
Provider Second Line Business Mailing Address:
A100
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-327-0460
Provider Business Mailing Address Fax Number:
520-795-0225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6565 E CARONDELET DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85710-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-547-3919
Provider Business Practice Location Address Fax Number:
520-547-3922
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CORCORAN
Authorized Official First Name:
TEREASA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOC DIR OPERATIONS SAFETY OFFICER
Authorized Official Telephone Number:
248-894-1691

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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