Provider Demographics
NPI:1124326558
Name:WEST AJO MEDICAL CENTER LTD.
Entity type:Organization
Organization Name:WEST AJO MEDICAL CENTER LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:520-573-0993
Mailing Address - Street 1:101 W AJO WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-6036
Mailing Address - Country:US
Mailing Address - Phone:520-573-0993
Mailing Address - Fax:520-573-0440
Practice Address - Street 1:101 W AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6036
Practice Address - Country:US
Practice Address - Phone:520-573-0993
Practice Address - Fax:520-573-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10458OtherPACIFICARE
AZ1992894380OtherUNITED HEALTH CARE
AZAZ0060530OtherBLUE CROSS/BLUE SHIELD
AZ0004660256OtherAETNA
AZ0004660256OtherAETNA