Provider Demographics
NPI:1245432665
Name:THUNDERBIRD OBSTETRICS & GYNECOLOGY, LTD.
Entity Type:Organization
Organization Name:THUNDERBIRD OBSTETRICS & GYNECOLOGY, LTD.
Other - Org Name:LINCOLN OBSTETRICS & GYNECOLOGY, LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURIZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GALASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-678-1111
Mailing Address - Street 1:5757 W. THUNDERBIRD ROAD
Mailing Address - Street 2:SUITE W202
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-5612
Mailing Address - Country:US
Mailing Address - Phone:602-678-1111
Mailing Address - Fax:602-678-7090
Practice Address - Street 1:5757 W. THUNDERBIRD ROAD
Practice Address - Street 2:SUITE W202
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-5612
Practice Address - Country:US
Practice Address - Phone:602-678-1111
Practice Address - Fax:602-678-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWDBDXMedicare ID - Type Unspecified