Basic Information
| Provider Information | |||||||||
| NPI: | 1487014882 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SMSJ TUCSON HOLDINGS, LLC | ||||||||
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| OtherOrganizationName: | ST. MARY'S HOSPITAL MEDICAL MALL AT GREEN VALLEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 N SILVERBELL RD | ||||||||
| Address2: | SUITE 185 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206092509 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 W CAMINO CASA VERDE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GREEN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856143564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208724555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2016 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | CORMIER | ||||||||
| AuthorizedOfficialFirstName: | CRISTIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9157472634 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.