Provider Demographics
NPI:1558318345
Name:ASSOCIATED INTERNISTS OF TUCSON, PLLC
Entity type:Organization
Organization Name:ASSOCIATED INTERNISTS OF TUCSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASTIAMPILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-429-5316
Mailing Address - Street 1:PO BOX 16397
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-6397
Mailing Address - Country:US
Mailing Address - Phone:520-296-1206
Mailing Address - Fax:520-296-7410
Practice Address - Street 1:6501 E SANTA AURELIA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3127
Practice Address - Country:US
Practice Address - Phone:520-296-1206
Practice Address - Fax:520-296-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ100281Medicare PIN