Provider Demographics
NPI:1215424668
Name:TUCSON/LENOX, LLC - HEALTH CLINIC
Entity type:Organization
Organization Name:TUCSON/LENOX, LLC - HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-749-9655
Mailing Address - Street 1:8600 E. ROCKCLIFF ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-9733
Mailing Address - Country:US
Mailing Address - Phone:520-749-9655
Mailing Address - Fax:520-749-0662
Practice Address - Street 1:8600 E. ROCKCLIFF ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-9733
Practice Address - Country:US
Practice Address - Phone:520-749-9655
Practice Address - Fax:520-749-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC8497261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center