Provider Demographics
NPI:1558808345
Name:TUCSON NEUROSCIENCE CENTER, P.L.L.C.
Entity Type:Organization
Organization Name:TUCSON NEUROSCIENCE CENTER, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FORRER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-721-1000
Mailing Address - Street 1:4015 E PARADISE FALLS DR
Mailing Address - Street 2:SUITE 132
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6700
Mailing Address - Country:US
Mailing Address - Phone:520-721-1000
Mailing Address - Fax:520-318-4766
Practice Address - Street 1:4015 E PARADISE FALLS DR
Practice Address - Street 2:SUITE 132
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6700
Practice Address - Country:US
Practice Address - Phone:520-721-1000
Practice Address - Fax:520-318-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ192962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ295031Medicaid
AZ295031Medicaid