Provider Demographics
NPI:1194797795
Name:JAMES A TAMMARO MD PC
Entity type:Organization
Organization Name:JAMES A TAMMARO MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAMMARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-855-9477
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-3360
Mailing Address - Country:US
Mailing Address - Phone:928-855-9477
Mailing Address - Fax:928-855-1799
Practice Address - Street 1:40 CAPRI BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5661
Practice Address - Country:US
Practice Address - Phone:928-855-9477
Practice Address - Fax:928-855-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
AZ05-08778332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03C0001024OtherMEDICARE NSC
AZ077182Medicaid
AZAZ0200500OtherBCBS
AZCS0262Medicare PIN
AZ490001705Medicare PIN
AZAZ0200500OtherBCBS