Provider Demographics
NPI:1316258361
Name:DESERT SKY SPINE & SPORTS MEDICINE PC
Entity type:Organization
Organization Name:DESERT SKY SPINE & SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:COURY
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:520-229-2080
Mailing Address - Street 1:6585 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5614
Mailing Address - Country:US
Mailing Address - Phone:520-229-2080
Mailing Address - Fax:520-229-2092
Practice Address - Street 1:6585 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5614
Practice Address - Country:US
Practice Address - Phone:520-229-2080
Practice Address - Fax:520-229-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0052262081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ534887Medicaid