1912093873 NPI number — TUCSON PATHOLOGY ASSOCIATES P.C.

Table of content: (NPI 1912093873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912093873 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:
1912093873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 42210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85080-2210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-889-7403
Provider Business Mailing Address Fax Number:
623-889-7407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7350 E SPEEDWAY BLVD
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:
85710-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-396-4757
Provider Business Practice Location Address Fax Number:
520-207-7986
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DE LA TORRE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
C.O.O.
Authorized Official Telephone Number:
602-685-5211

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 207ZP0105X , 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: 298110 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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