Provider Demographics
NPI:1053509679
Name:UNIVERSITY OF ARIZONA
Entity Type:Organization
Organization Name:UNIVERSITY OF ARIZONA
Other - Org Name:UNIVERSITY OF ARIZONA SPEECH & HEARING CLINICS
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPARTMENT HEAD
Authorized Official - Prefix:DR
Authorized Official - First Name:PELAGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEESON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-621-9879
Mailing Address - Street 1:1131 E. 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0071
Mailing Address - Country:US
Mailing Address - Phone:520-621-7070
Mailing Address - Fax:520-621-9901
Practice Address - Street 1:1131 E. 2ND STREET
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721
Practice Address - Country:US
Practice Address - Phone:520-626-0620
Practice Address - Fax:520-626-5215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ARIZONA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ148131Medicare PIN
AZZ148131Medicare PIN