1720294424 NPI number — TUCSON PATHOLOGY ASSOCIATES, P.C.

Table of content: (NPI 1720294424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720294424 NPI number — TUCSON PATHOLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUCSON PATHOLOGY ASSOCIATES, P.C.
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:
Provider Other Organization Name Type Code:
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:
1720294424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6810 E BROADWAY BLVD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85710-2838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-298-4589
Provider Business Mailing Address Fax Number:
520-298-5236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 N WILMOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85711-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-873-3929
Provider Business Practice Location Address Fax Number:
520-873-3742
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COUCH
Authorized Official First Name:
WELDON
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-298-4589

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  12487 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com