Provider Demographics
NPI:1003074758
Name:ARIZONA COMMUNITY SURGEONS PC
Entity Type:Organization
Organization Name:ARIZONA COMMUNITY SURGEONS PC
Other - Org Name:SOUTHERN ARIZONA ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-382-9246
Mailing Address - Street 1:PO BOX 13627
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-3627
Mailing Address - Country:US
Mailing Address - Phone:520-750-7160
Mailing Address - Fax:520-886-1929
Practice Address - Street 1:6567 E CARONDELET DR
Practice Address - Street 2:SUITE 415
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2156
Practice Address - Country:US
Practice Address - Phone:520-885-6701
Practice Address - Fax:520-885-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ230658OtherAHCCCS
AZ230658OtherAHCCCS
AZZ107582Medicare PIN