Provider Demographics
NPI:1467021121
Name:UROLOGY CARE CLINIC LLC
Entity Type:Organization
Organization Name:UROLOGY CARE CLINIC LLC
Other - Org Name:UROLOGY CARE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-321-9887
Mailing Address - Street 1:6001 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2316
Mailing Address - Country:US
Mailing Address - Phone:520-497-5010
Mailing Address - Fax:520-497-4111
Practice Address - Street 1:6001 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2316
Practice Address - Country:US
Practice Address - Phone:520-497-5010
Practice Address - Fax:520-497-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1235573742Medicaid