Provider Demographics
NPI:1194917492
Name:CATALINA GASTROENTEROLOGY
Entity type:Organization
Organization Name:CATALINA GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-297-3911
Mailing Address - Street 1:PO BOX 36205
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6205
Mailing Address - Country:US
Mailing Address - Phone:520-297-3911
Mailing Address - Fax:520-297-3955
Practice Address - Street 1:1845 W ORANGE GROVE RD
Practice Address - Street 2:#125
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1134
Practice Address - Country:US
Practice Address - Phone:520-297-3911
Practice Address - Fax:520-297-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ31258207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ73104Medicare PIN
AZH98007Medicare UPIN