Provider Demographics
NPI:1386419000
Name:GASTROENTEROLOGY OF ARIZONA, PLLC
Entity type:Organization
Organization Name:GASTROENTEROLOGY OF ARIZONA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-761-0707
Mailing Address - Street 1:2820 N PINAL AVE STE 12-467
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-7918
Mailing Address - Country:US
Mailing Address - Phone:602-761-0707
Mailing Address - Fax:520-231-9556
Practice Address - Street 1:600 WEST HIGHWAY 260
Practice Address - Street 2:SUITE #9
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541
Practice Address - Country:US
Practice Address - Phone:602-761-0707
Practice Address - Fax:520-231-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty