Provider Demographics
NPI:1497805360
Name:WEST HORIZON MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:WEST HORIZON MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SUREKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDLAMURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-622-7675
Mailing Address - Street 1:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:STE. 245
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2675
Practice Address - Country:US
Practice Address - Phone:520-622-7675
Practice Address - Fax:520-628-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31764207R00000X
AZ11203208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH90390Medicare UPIN
AZC99712Medicare UPIN
AZZ22361Medicare PIN