Provider Demographics
NPI:1720057664
Name:T BRYSON STRUSE
Entity Type:Organization
Organization Name:T BRYSON STRUSE
Other - Org Name:TUCSON DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:T
Authorized Official - Middle Name:BRYSON
Authorized Official - Last Name:STRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-696-2300
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:4892 N STONE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5761
Practice Address - Country:US
Practice Address - Phone:520-696-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005604Medicaid
AZ1Z3434OtherHEALTH NET OF AZ
AZAZ0045850OtherBCBS AZ
AZAZ0045850OtherBCBS AZ