Provider Demographics
NPI:1790827574
Name:NORTHWEST CENTER FOR GERIATRIC MEDICINE
Entity Type:Organization
Organization Name:NORTHWEST CENTER FOR GERIATRIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:PIFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-297-8429
Mailing Address - Street 1:PO BOX 36210
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6210
Mailing Address - Country:US
Mailing Address - Phone:520-297-8429
Mailing Address - Fax:520-297-2913
Practice Address - Street 1:6130 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE #117
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3557
Practice Address - Country:US
Practice Address - Phone:520-297-8429
Practice Address - Fax:520-297-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ21379Medicare ID - Type Unspecified