Provider Demographics
NPI:1659059145
Name:ALLIED INTEGRATED CLINIC TUCSON LLC
Entity Type:Organization
Organization Name:ALLIED INTEGRATED CLINIC TUCSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-287-4545
Mailing Address - Street 1:6418 E TANQUE VERDE RD STE 103-105
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3846
Mailing Address - Country:US
Mailing Address - Phone:480-287-4545
Mailing Address - Fax:
Practice Address - Street 1:6418 E TANQUE VERDE RD STE 103-105
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3846
Practice Address - Country:US
Practice Address - Phone:480-287-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC12595OtherAZDHS