Provider Demographics
NPI:1144253295
Name:ARIZONA UROLOGIC SPECIALISTS
Entity type:Organization
Organization Name:ARIZONA UROLOGIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:KALOTA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:520-733-3030
Mailing Address - Street 1:6252 E GRANT RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5803
Mailing Address - Country:US
Mailing Address - Phone:520-733-3030
Mailing Address - Fax:520-733-1177
Practice Address - Street 1:6252 E GRANT RD
Practice Address - Street 2:SUITE 150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5803
Practice Address - Country:US
Practice Address - Phone:520-733-3030
Practice Address - Fax:520-733-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ28232Medicare PIN
AZ0833320001Medicare NSC