Provider Demographics
NPI:1366640021
Name:UNIVERSITY MEDICAL CENTER TUCSON, ARIZONA
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL CENTER TUCSON, ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EKENE
Authorized Official - Middle Name:IFEANYI
Authorized Official - Last Name:OKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-287-0347
Mailing Address - Street 1:255 N GRANADA AVE APT 13102
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-7721
Mailing Address - Country:US
Mailing Address - Phone:210-287-0347
Mailing Address - Fax:
Practice Address - Street 1:255 N GRANADA AVE APT 13102
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-7721
Practice Address - Country:US
Practice Address - Phone:210-287-0347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81955281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital