Provider Demographics
NPI:1972834984
Name:CARONDELET MEDICAL GROUP INC
Entity type:Organization
Organization Name:CARONDELET MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-872-7076
Mailing Address - Street 1:PO BOX 29347
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9347
Mailing Address - Country:US
Mailing Address - Phone:520-872-7000
Mailing Address - Fax:520-872-7969
Practice Address - Street 1:630 N ALVERNON WAY STE 251
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1879
Practice Address - Country:US
Practice Address - Phone:520-319-3283
Practice Address - Fax:520-319-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0585213ES0103X
AZ647213ES0103X
AZ0666213ES0103X
AZ0546213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5110620001Medicare NSC