Basic Information
| Provider Information | |||||||||
| NPI: | 1194983841 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA COMMUNITY SURGEONS, P. C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1951 N WILMOT ROAD | ||||||||
| Address2: | BUILD #2 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857128000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207507160 | ||||||||
| FaxNumber: | 5208861929 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 N ALVERNON WAY STE 161 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857111895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208812600 | ||||||||
| FaxNumber: | 5208812844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCINTYRE | ||||||||
| AuthorizedOfficialFirstName: | JODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5207507160 | ||||||||
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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 |