Provider Demographics
NPI:1124451364
Name:ARIZONA CT SURGERY LLC
Entity type:Organization
Organization Name:ARIZONA CT SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUDSPETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-861-1800
Mailing Address - Street 1:485 S DOBSON RD
Mailing Address - Street 2:STE 111
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5602
Mailing Address - Country:US
Mailing Address - Phone:480-407-4999
Mailing Address - Fax:480-407-4998
Practice Address - Street 1:485 S DOBSON RD
Practice Address - Street 2:STE 111
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5602
Practice Address - Country:US
Practice Address - Phone:480-407-4999
Practice Address - Fax:480-407-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23299208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD93518Medicare UPIN