Provider Demographics
NPI:1275771719
Name:REI II
Entity Type:Organization
Organization Name:REI II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GELETY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-326-0001
Mailing Address - Street 1:5190 E FARNESS DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2142
Mailing Address - Country:US
Mailing Address - Phone:520-326-0001
Mailing Address - Fax:520-326-7451
Practice Address - Street 1:5190 E FARNESS DR
Practice Address - Street 2:SUITE 114
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2142
Practice Address - Country:US
Practice Address - Phone:520-326-0001
Practice Address - Fax:520-326-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory