Provider Demographics
NPI:1316977580
Name:IRONWOOD OB/GYN, P C
Entity type:Organization
Organization Name:IRONWOOD OB/GYN, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHUPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-881-1977
Mailing Address - Street 1:2300 N ROSEMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2139
Mailing Address - Country:US
Mailing Address - Phone:520-881-1977
Mailing Address - Fax:520-881-1979
Practice Address - Street 1:2300 N ROSEMONT BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2139
Practice Address - Country:US
Practice Address - Phone:520-881-1977
Practice Address - Fax:520-881-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ458853-01Medicaid
AZ285892-01Medicaid
AZ397077-01Medicaid
AZ567802-03Medicaid
AZ258005-02Medicaid
AZ518269-03Medicaid
AZH15879Medicare UPIN
78657Medicare ID - Type Unspecified
AZ567802-03Medicaid
16WCJAQ08Medicare ID - Type Unspecified
16WCJAQ04Medicare ID - Type Unspecified
AZ258005-02Medicaid
26221Medicare ID - Type Unspecified
16WCJAQ07Medicare ID - Type Unspecified
AZ458853-01Medicaid
AZ397077-01Medicaid
AZD37768Medicare UPIN
AZG04816Medicare UPIN