Provider Demographics
NPI:1134569700
Name:UNIVERSITY OF MEDICAL SCIENCES ARIZONA
Entity type:Organization
Organization Name:UNIVERSITY OF MEDICAL SCIENCES ARIZONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ACTING DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-442-8059
Mailing Address - Street 1:125 S AVONDALE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5212
Mailing Address - Country:US
Mailing Address - Phone:480-442-8059
Mailing Address - Fax:
Practice Address - Street 1:125 S AVONDALE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5212
Practice Address - Country:US
Practice Address - Phone:480-442-8059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation