Provider Demographics
NPI:1346560711
Name:SOUTHERN ARIZONA RHEUMATOLOGY
Entity Type:Organization
Organization Name:SOUTHERN ARIZONA RHEUMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-319-3956
Mailing Address - Street 1:630 N ALVERNON WAY
Mailing Address - Street 2:SUITE 371
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1843
Mailing Address - Country:US
Mailing Address - Phone:520-319-3956
Mailing Address - Fax:520-319-3913
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:SUITE 371
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1843
Practice Address - Country:US
Practice Address - Phone:520-319-3956
Practice Address - Fax:520-319-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22963332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment