Provider Demographics
NPI:1568592558
Name:TUCSON VASCULAR SURGERY
Entity Type:Organization
Organization Name:TUCSON VASCULAR SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUBBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-628-8686
Mailing Address - Street 1:PO BOX 85727
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-5727
Mailing Address - Country:US
Mailing Address - Phone:520-628-8686
Mailing Address - Fax:520-297-0626
Practice Address - Street 1:1815 W ST. MARY'S RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-628-1400
Practice Address - Fax:520-628-4863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ102542Medicare ID - Type UnspecifiedMEDICARE ID NUMBER