Provider Demographics
NPI:1215289913
Name:WESTERN NEUROSURGERY LTD.
Entity type:Organization
Organization Name:WESTERN NEUROSURGERY LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-881-8400
Mailing Address - Street 1:6567 E CARONDELET DR STE 305
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6160
Mailing Address - Country:US
Mailing Address - Phone:520-881-8400
Mailing Address - Fax:520-881-6563
Practice Address - Street 1:6567 E CARONDELET DR STE 305
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6160
Practice Address - Country:US
Practice Address - Phone:520-881-8400
Practice Address - Fax:520-881-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5249363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty