Provider Demographics
NPI:1548253453
Name:TUCSON GASTROENTEROLOGY SPECIALISTS, PC
Entity type:Organization
Organization Name:TUCSON GASTROENTEROLOGY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HURTADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-327-3454
Mailing Address - Street 1:3040 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1225
Mailing Address - Country:US
Mailing Address - Phone:520-327-3454
Mailing Address - Fax:520-327-3431
Practice Address - Street 1:3040 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1225
Practice Address - Country:US
Practice Address - Phone:520-327-3454
Practice Address - Fax:520-327-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWMBKDMedicare ID - Type UnspecifiedMEDICARE GROUP ID