Provider Demographics
NPI:1124208269
Name:SAGUARO SURGICAL, P C
Entity Type:Organization
Organization Name:SAGUARO SURGICAL, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-318-3004
Mailing Address - Street 1:6422 E SPEEDWAY BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1148
Mailing Address - Country:US
Mailing Address - Phone:520-318-3004
Mailing Address - Fax:520-318-3061
Practice Address - Street 1:6422 E SPEEDWAY BLVD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1149
Practice Address - Country:US
Practice Address - Phone:520-318-3004
Practice Address - Fax:520-318-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA28838Medicare UPIN
AZH80782Medicare UPIN
AZE68823Medicare UPIN
AZQ41916Medicare UPIN
AZZ22321Medicare PIN
AZE94901Medicare UPIN
AZE92887Medicare UPIN