Provider Demographics
NPI:1518219740
Name:ARIZONA MEDICOS INC
Entity Type:Organization
Organization Name:ARIZONA MEDICOS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-409-3445
Mailing Address - Street 1:120 W CALLE DE LAS TIENDAS
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4326
Mailing Address - Country:US
Mailing Address - Phone:866-862-6414
Mailing Address - Fax:866-851-4817
Practice Address - Street 1:120 W CALLE DE LAS TIENDAS
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4326
Practice Address - Country:US
Practice Address - Phone:866-862-6414
Practice Address - Fax:866-851-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center