Provider Demographics
NPI:1114110053
Name:CARONDELET HEALTH NETWORK
Entity Type:Organization
Organization Name:CARONDELET HEALTH NETWORK
Other - Org Name:CARONDELET MEDICAL MALL AT RITA RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFIER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEPPING
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:520-872-7790
Mailing Address - Street 1:2202 NORTH FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-872-7700
Mailing Address - Fax:
Practice Address - Street 1:8290 SOUTH HOUGHTON ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9702
Practice Address - Country:US
Practice Address - Phone:520-872-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-4226261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTH-4226OtherAZ STATE LICENSE
AZ030011Medicare Oscar/Certification