Provider Demographics
NPI:1144219460
Name:TANQUE VERDE AUDIOLOGY INC
Entity type:Organization
Organization Name:TANQUE VERDE AUDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DR OF AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUCH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:520-825-4770
Mailing Address - Street 1:7255 E TANQUE VERDE RD
Mailing Address - Street 2:#131
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3463
Mailing Address - Country:US
Mailing Address - Phone:520-751-3901
Mailing Address - Fax:520-751-4102
Practice Address - Street 1:7255 E TANQUE VERDE RD
Practice Address - Street 2:#131
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3463
Practice Address - Country:US
Practice Address - Phone:520-751-3901
Practice Address - Fax:520-751-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1960231H00000X
AZDA1790231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1Z6108OtherHEALTH NET OF ARIZONA
AZ0902980OtherBLUE CROSS BLUE SHIELD
AZ0902980OtherBLUE CROSS BLUE SHIELD
AZ264749Medicare ID - Type Unspecified
P37803Medicare UPIN