Provider Demographics
NPI:1871632604
Name:SOUTHERN ARIZONA CENTER FOR MINIMALLY INVASIVE SURGERY, PC
Entity Type:Organization
Organization Name:SOUTHERN ARIZONA CENTER FOR MINIMALLY INVASIVE SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHIASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-219-8690
Mailing Address - Street 1:6320 N LA CHOLLA BLVD
Mailing Address - Street 2:STE 380
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741
Mailing Address - Country:US
Mailing Address - Phone:520-219-8690
Mailing Address - Fax:520-219-8694
Practice Address - Street 1:6320 N LA CHOLLA BLVD
Practice Address - Street 2:STE 380
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-219-8690
Practice Address - Fax:520-219-8694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31226208600000X
AZ29820208600000X
AZ2649363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72823Medicare ID - Type UnspecifiedGROUP NUMBER