Provider Demographics
NPI:1841245909
Name:VIRGINIA RUTZ DO PLLC
Entity Type:Organization
Organization Name:VIRGINIA RUTZ DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MULCAHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA, BSN
Authorized Official - Phone:480-357-3904
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:AZ
Mailing Address - Zip Code:85237-0369
Mailing Address - Country:US
Mailing Address - Phone:520-363-5573
Mailing Address - Fax:520-363-5611
Practice Address - Street 1:100 TILBURY
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:AZ
Practice Address - Zip Code:85237
Practice Address - Country:US
Practice Address - Phone:520-363-5573
Practice Address - Fax:520-363-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G29582Medicare UPIN