Provider Demographics
NPI:1770742959
Name:UNIVERSITY PHYSICIANS HEALTHCARE
Entity type:Organization
Organization Name:UNIVERSITY PHYSICIANS HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PAYOR RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOTISKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-874-2863
Mailing Address - Street 1:2701 EAST ELVIRA ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-2863
Mailing Address - Fax:520-874-7048
Practice Address - Street 1:2800 E. AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-3204
Practice Address - Country:US
Practice Address - Phone:520-874-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY PHYSICIANS HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-03
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH 3421261QM0850X, 261QM0855X
AZH3577273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03S111Medicare Oscar/Certification