Provider Demographics
NPI:1275565509
Name:SOUTHERN ARIZONA INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:SOUTHERN ARIZONA INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-795-4100
Mailing Address - Street 1:5210 E FARNESS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2140
Mailing Address - Country:US
Mailing Address - Phone:520-795-4100
Mailing Address - Fax:520-795-4224
Practice Address - Street 1:5210 E FARNESS DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2140
Practice Address - Country:US
Practice Address - Phone:520-795-4100
Practice Address - Fax:520-795-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ869365Medicaid