Provider Demographics
NPI:1285676643
Name:PULMONARY ASSOCIATES OF SOUTHERN ARIZONA, PC
Entity Type:Organization
Organization Name:PULMONARY ASSOCIATES OF SOUTHERN ARIZONA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-318-1114
Mailing Address - Street 1:1951 N WILMOT RD
Mailing Address - Street 2:BLDG 4
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-8000
Mailing Address - Country:US
Mailing Address - Phone:520-318-1114
Mailing Address - Fax:520-318-4693
Practice Address - Street 1:1951 N WILMOT RD
Practice Address - Street 2:BLDG 4
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-8000
Practice Address - Country:US
Practice Address - Phone:520-318-1114
Practice Address - Fax:520-318-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207RP1001X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ508236Medicaid
AZ235707Medicaid
AZ508236Medicaid