Provider Demographics
NPI:1841322625
Name:SOUTHWESTERN UROLOGY, PLLC
Entity type:Organization
Organization Name:SOUTHWESTERN UROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-296-7169
Mailing Address - Street 1:1100 N EL DORADO PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4606
Mailing Address - Country:US
Mailing Address - Phone:520-296-7169
Mailing Address - Fax:520-885-5806
Practice Address - Street 1:1100 N EL DORADO PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4606
Practice Address - Country:US
Practice Address - Phone:520-296-7169
Practice Address - Fax:520-885-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1780643015OtherJERRY GREENBERG NPI
AZ1619936002OtherERIC CASTANEDA NPI
AZ1053370031OtherLEON SMITH HARRISON NPI
AZ1710946744OtherKIMBALL ORTON NPI