Basic Information
| Provider Information | |||||||||
| NPI: | 1487690954 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY SURGICAL SERVICES OF ARIZONA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16488 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857326488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207507162 | ||||||||
| FaxNumber: | 5208861929 | ||||||||
| Practice Location | |||||||||
| Address1: | 6300 E EL DORADO PLZ | ||||||||
| Address2: | STE A220 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857154612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207507162 | ||||||||
| FaxNumber: | 5208861929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | CHOZA | ||||||||
| AuthorizedOfficialFirstName: | CONNIE | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5207507162 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 078420 | 05 | AZ | MEDICAID |