1992168785 NPI number — SURGICAL INSTITUTE OF TUCSON, LLC

Table of content: (NPI 1992168785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992168785 NPI number — SURGICAL INSTITUTE OF TUCSON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL INSTITUTE OF TUCSON, LLC
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:
1992168785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4787 E CAMP LOWELL DR
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:
85712-1256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-204-1495
Provider Business Mailing Address Fax Number:
623-218-1215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 S ALVERNON WAY
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:
85711-5351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-204-1495
Provider Business Practice Location Address Fax Number:
623-218-1215
Provider Enumeration Date:
03/30/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LEWANDROWSKI
Authorized Official First Name:
KAI-UWE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-204-1495

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  MED6545 , 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)





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