Basic Information
| Provider Information | |||||||||
| NPI: | 1003074758 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARIZONA COMMUNITY SURGEONS PC | ||||||||
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| OtherOrganizationName: | SOUTHERN ARIZONA ORTHOPEDICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13627 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857323627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207507160 | ||||||||
| FaxNumber: | 5208861929 | ||||||||
| Practice Location | |||||||||
| Address1: | 6567 E CARONDELET DR | ||||||||
| Address2: | SUITE 415 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857102156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208856701 | ||||||||
| FaxNumber: | 5208859037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 04/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | DEVRIES | ||||||||
| AuthorizedOfficialFirstName: | J | ||||||||
| AuthorizedOfficialMiddleName: | RONALD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5203829246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 230658 | 01 | AZ | AHCCCS | OTHER |