Provider Demographics
NPI:1700931797
Name:NEUROLOGY-CHILD NEUROLOGY OF TUCSON, PC
Entity Type:Organization
Organization Name:NEUROLOGY-CHILD NEUROLOGY OF TUCSON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-745-2086
Mailing Address - Street 1:5610 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2239
Mailing Address - Country:US
Mailing Address - Phone:520-745-2086
Mailing Address - Fax:520-296-5105
Practice Address - Street 1:5610 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2239
Practice Address - Country:US
Practice Address - Phone:520-745-2086
Practice Address - Fax:520-296-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6309261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z072409948Medicare PIN
D36931Medicare UPIN