Provider Demographics
NPI:1881884633
Name:JAMES W COLAVITO
Entity type:Organization
Organization Name:JAMES W COLAVITO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:COLAVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-323-9500
Mailing Address - Street 1:5410 E PIMA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3634
Mailing Address - Country:US
Mailing Address - Phone:520-323-9500
Mailing Address - Fax:520-323-3510
Practice Address - Street 1:5410 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3634
Practice Address - Country:US
Practice Address - Phone:520-323-9500
Practice Address - Fax:520-323-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4560880001Medicare NSC