Provider Demographics
NPI:1891978516
Name:CARONDELET SPECIALIST GROUP, INC
Entity Type:Organization
Organization Name:CARONDELET SPECIALIST GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/CHIEF STRA
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:520-872-7638
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:520-872-7265
Mailing Address - Fax:520-872-7929
Practice Address - Street 1:2202 N. FORBES BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1412
Practice Address - Country:US
Practice Address - Phone:520-872-7265
Practice Address - Fax:520-872-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29552208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ325160Medicaid
AZZ120899Medicare PIN