Provider Demographics
NPI:1417909441
Name:JAVIER R. RIOS M.D. A MEDICAL PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:JAVIER R. RIOS M.D. A MEDICAL PROFESSIONAL CORP.
Other - Org Name:TUCSON CLINICA MEDICA FAMILIAR/URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-620-1200
Mailing Address - Street 1:3770 S 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-6081
Mailing Address - Country:US
Mailing Address - Phone:520-620-1200
Mailing Address - Fax:520-620-0245
Practice Address - Street 1:3770 S 16TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6081
Practice Address - Country:US
Practice Address - Phone:520-620-1200
Practice Address - Fax:520-620-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30370261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF94071Medicare UPIN
AZZ78590Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #