Provider Demographics
NPI:1700964038
Name:MD MED INC
Entity type:Organization
Organization Name:MD MED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:P
Authorized Official - Last Name:TRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-439-4441
Mailing Address - Street 1:PO BOX 3010
Mailing Address - Street 2:MD MED INC
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85636-3010
Mailing Address - Country:US
Mailing Address - Phone:520-439-4441
Mailing Address - Fax:520-439-8762
Practice Address - Street 1:155 CALLE PORTAL SUITE 700
Practice Address - Street 2:SIERRA VISTA CANCER CENTER
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-459-1718
Practice Address - Fax:520-458-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ68496Medicare ID - Type Unspecified