Provider Demographics
NPI:1295859213
Name:FOOTHILLS GASTROENTEROLOGY PLLC
Entity Type:Organization
Organization Name:FOOTHILLS GASTROENTEROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:OAXACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-818-3680
Mailing Address - Street 1:1521 E TANGERINE RD
Mailing Address - Street 2:SUITE 283
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-6225
Mailing Address - Country:US
Mailing Address - Phone:520-818-3680
Mailing Address - Fax:520-901-2981
Practice Address - Street 1:1521 E TANGERINE RD
Practice Address - Street 2:SUITE 283
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6225
Practice Address - Country:US
Practice Address - Phone:520-818-3680
Practice Address - Fax:520-901-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ72050Medicare PIN