Provider Demographics
NPI:1740230770
Name:CARONDELET HEALTH NETWORK
Entity Type:Organization
Organization Name:CARONDELET HEALTH NETWORK
Other - Org Name:CARONDELET MEDICAL MALL AT GREEN VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-872-7790
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-872-7700
Mailing Address - Fax:520-872-7508
Practice Address - Street 1:400 W CAMINO CASA VERDE
Practice Address - Street 2:SUITE 200
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3564
Practice Address - Country:US
Practice Address - Phone:520-872-4568
Practice Address - Fax:820-872-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH0011261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111680Medicare ID - Type UnspecifiedOUT PT. CMM GREEN VALLEY