Provider Demographics
NPI:1881683126
Name:TUCSON MEDICAL CENTER
Entity Type:Organization
Organization Name:TUCSON MEDICAL CENTER
Other - Org Name:PALO VERDE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SR VP - CFO
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:
Authorized Official - Last Name:TANPIENGCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-324-1160
Mailing Address - Street 1:PO BOX 31267
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-324-4952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUCSON MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-19
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH-0012273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020462Medicaid
AZZT03000601Medicare PIN
AZ020462Medicaid