Provider Demographics
NPI:1194983841
Name:ARIZONA COMMUNITY SURGEONS, P. C.
Entity type:Organization
Organization Name:ARIZONA COMMUNITY SURGEONS, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-750-7160
Mailing Address - Street 1:1951 N WILMOT ROAD
Mailing Address - Street 2:BUILD #2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-8000
Mailing Address - Country:US
Mailing Address - Phone:520-750-7160
Mailing Address - Fax:520-886-1929
Practice Address - Street 1:630 N ALVERNON WAY STE 161
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1895
Practice Address - Country:US
Practice Address - Phone:520-881-2600
Practice Address - Fax:520-881-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ230658OtherAHCCCS
AZZ107582Medicare PIN