Provider Demographics
NPI:1245700616
Name:ISMILE CMS
Entity type:Organization
Organization Name:ISMILE CMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-889-3358
Mailing Address - Street 1:4600 S PARK AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-1697
Mailing Address - Country:US
Mailing Address - Phone:520-889-3358
Mailing Address - Fax:520-889-3350
Practice Address - Street 1:4600 S PARK AVE STE 6
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1697
Practice Address - Country:US
Practice Address - Phone:520-889-3358
Practice Address - Fax:520-889-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========1OtherNEED GROUP NPI