1841322625 NPI number — SOUTHWESTERN UROLOGY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841322625 NPI number — SOUTHWESTERN UROLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWESTERN UROLOGY, PLLC
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:
1841322625
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:
1100 N EL DORADO PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85715-4606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-296-7169
Provider Business Mailing Address Fax Number:
520-885-5806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 N EL DORADO PL
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:
85715-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-296-7169
Provider Business Practice Location Address Fax Number:
520-885-5806
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAMBLIN
Authorized Official First Name:
JEANNIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
520-296-7169

Provider Taxonomy Codes

  • Taxonomy code: 2088P0231X , 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)

  • Identifier: 1780643015 . This is a "JERRY GREENBERG NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1619936002 . This is a "ERIC CASTANEDA NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1053370031 . This is a "LEON SMITH HARRISON NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1710946744 . This is a "KIMBALL ORTON NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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