Provider Demographics
NPI:1114013232
Name:TRANSMED OF SOUTHERN ARIZONA
Entity Type:Organization
Organization Name:TRANSMED OF SOUTHERN ARIZONA
Other - Org Name:TRANSMED
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-439-4340
Mailing Address - Street 1:1100 JOSHUA TREE DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-1256
Mailing Address - Country:US
Mailing Address - Phone:520-439-4340
Mailing Address - Fax:520-458-0798
Practice Address - Street 1:1100 JOSHUA TREE DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1256
Practice Address - Country:US
Practice Address - Phone:520-439-4340
Practice Address - Fax:520-458-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ549694261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ549694OtherAHCCCS