Provider Demographics
NPI:1508437385
Name:SPEEDWAY SURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SPEEDWAY SURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMANNY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD/MBA
Authorized Official - Phone:520-777-4090
Mailing Address - Street 1:6442 E SPEEDWAY BLVD STE 152
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-0013
Mailing Address - Country:US
Mailing Address - Phone:520-771-8175
Mailing Address - Fax:520-771-9194
Practice Address - Street 1:6442 E SPEEDWAY BLVD STE 152
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1134
Practice Address - Country:US
Practice Address - Phone:520-771-8175
Practice Address - Fax:520-771-9402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPEEDWAY SURGICAL SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-02
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical