Provider Demographics
NPI:1083622997
Name:TATUM RIDGE INTERNAL MEDICINE PLC
Entity Type:Organization
Organization Name:TATUM RIDGE INTERNAL MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-971-5500
Mailing Address - Street 1:18404 N TATUM BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1509
Mailing Address - Country:US
Mailing Address - Phone:602-971-5500
Mailing Address - Fax:602-944-0504
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:STE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1509
Practice Address - Country:US
Practice Address - Phone:602-971-5500
Practice Address - Fax:602-944-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB38749Medicare UPIN
AZE90081Medicare UPIN
AZ63515Medicare PIN
AZD36801Medicare UPIN
AZH00069Medicare UPIN