Provider Demographics
NPI:1245491190
Name:MYPASSION4HEALTH
Entity type:Organization
Organization Name:MYPASSION4HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:ACKERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-299-5694
Mailing Address - Street 1:7533 N WINDOW PEAK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1376
Mailing Address - Country:US
Mailing Address - Phone:520-299-5694
Mailing Address - Fax:
Practice Address - Street 1:7533 N WINDOW PEAK RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1376
Practice Address - Country:US
Practice Address - Phone:520-299-5694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35392261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center