Basic Information
| Provider Information | |||||||||
| NPI: | 1780929141 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UROLOGIC SURGEONS OF ARIZONA PLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | USA PRIMARY CARE AND WELLNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6750 E BAYWOOD AVE | ||||||||
| Address2: | STE 507 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804095060 | ||||||||
| FaxNumber: | 4804095070 | ||||||||
| Practice Location | |||||||||
| Address1: | 6750 E BAYWOOD AVE | ||||||||
| Address2: | STE 507 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804095060 | ||||||||
| FaxNumber: | 4804095070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2012 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | ALVI | ||||||||
| AuthorizedOfficialFirstName: | KASHIF | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6023240437 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 770883 | 05 | AZ | MEDICAID |