Provider Demographics
NPI:1629260096
Name:ARIZONA INSTITUTE OF UROLOGY PLLC
Entity Type:Organization
Organization Name:ARIZONA INSTITUTE OF UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-202-0490
Mailing Address - Street 1:4811 E GRANT RD
Mailing Address - Street 2:261
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2771
Mailing Address - Country:US
Mailing Address - Phone:520-297-1345
Mailing Address - Fax:520-297-3539
Practice Address - Street 1:5670 N PROFESSIONAL PARK DR
Practice Address - Street 2:100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7878
Practice Address - Country:US
Practice Address - Phone:520-618-1010
Practice Address - Fax:520-784-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ250268Medicaid
AZZ117590OtherPTAN
AZZ117590Medicare PIN