Provider Demographics
NPI:1174668099
Name:SOUTHERN ARIZONA ORTHOPEDICS, P.C.
Entity Type:Organization
Organization Name:SOUTHERN ARIZONA ORTHOPEDICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-885-6701
Mailing Address - Street 1:6602 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2119
Mailing Address - Country:US
Mailing Address - Phone:520-885-6701
Mailing Address - Fax:520-885-9037
Practice Address - Street 1:6602 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2119
Practice Address - Country:US
Practice Address - Phone:520-885-6701
Practice Address - Fax:520-885-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Not Answered207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Not Answered207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Not Answered207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Not Answered207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ932394Medicaid
AZ201020Medicaid
AZ356346Medicaid
AZ224551Medicaid
=========OtherTAX ID
E39504Medicare UPIN
G32530Medicare UPIN
62172Medicare ID - Type Unspecified
AZ356346Medicaid
AZ201020Medicaid
H16795Medicare UPIN
AZ543290Medicare ID - Type Unspecified
103264Medicare ID - Type Unspecified
WCLGY04Medicare ID - Type Unspecified
AZ224551Medicaid
WCLGY01Medicare ID - Type Unspecified