Provider Demographics
NPI:1487690954
Name:EMERGENCY SURGICAL SERVICES OF ARIZONA, PLLC
Entity type:Organization
Organization Name:EMERGENCY SURGICAL SERVICES OF ARIZONA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-750-7162
Mailing Address - Street 1:PO BOX 16488
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-6488
Mailing Address - Country:US
Mailing Address - Phone:520-750-7162
Mailing Address - Fax:520-886-1929
Practice Address - Street 1:6300 E EL DORADO PLZ
Practice Address - Street 2:STE A220
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4612
Practice Address - Country:US
Practice Address - Phone:520-750-7162
Practice Address - Fax:520-886-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ078420Medicaid
AZ078420Medicaid