Provider Demographics
NPI:1205930500
Name:ORO VALLEY MEDICINE LLC
Entity type:Organization
Organization Name:ORO VALLEY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKASH
Authorized Official - Middle Name:AHARAD
Authorized Official - Last Name:TAGGARSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-429-8523
Mailing Address - Street 1:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:1171 E RANCHO VISTOSO BLVD STE 143
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-9101
Practice Address - Country:US
Practice Address - Phone:520-399-8094
Practice Address - Fax:888-416-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H88685Medicare UPIN
Z101255Medicare ID - Type Unspecified