Provider Demographics
NPI:1629007729
Name:SOUTHERN ARIZONA UROGYNECOLOGY CENTER PLLC
Entity Type:Organization
Organization Name:SOUTHERN ARIZONA UROGYNECOLOGY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SURWIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-795-9300
Mailing Address - Street 1:6296 E GRANT RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5833
Mailing Address - Country:US
Mailing Address - Phone:520-795-9300
Mailing Address - Fax:520-795-9305
Practice Address - Street 1:6296 E GRANT RD
Practice Address - Street 2:SUITE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5833
Practice Address - Country:US
Practice Address - Phone:520-795-9300
Practice Address - Fax:520-795-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11111207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ105968Medicare ID - Type Unspecified