Provider Demographics
NPI:1902979180
Name:CARONDELET ST MARYS CAMPUS LLC
Entity Type:Organization
Organization Name:CARONDELET ST MARYS CAMPUS LLC
Other - Org Name:CARONDELET SILVERBELL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TANNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-877-5665
Mailing Address - Street 1:2220 WEST ORANGE GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3117
Mailing Address - Country:US
Mailing Address - Phone:520-877-5660
Mailing Address - Fax:520-877-5669
Practice Address - Street 1:585 N SILVERBELL ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-623-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-05-20
Deactivation Date:2008-05-05
Deactivation Code:
Reactivation Date:2008-05-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ063515Medicaid
109453Medicare PIN
AZ063515Medicaid