Provider Demographics
NPI:1649685827
Name:UNIVERSITY OF ARIZONA INTERCOLLEGIATE ATHLETICS
Entity type:Organization
Organization Name:UNIVERSITY OF ARIZONA INTERCOLLEGIATE ATHLETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FOR ATHLETICS
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-621-4622
Mailing Address - Street 1:1 NATIONAL CHAMPIONSHIP DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0096
Mailing Address - Country:US
Mailing Address - Phone:520-621-4622
Mailing Address - Fax:520-621-9690
Practice Address - Street 1:1 NATIONAL CHAMPIONSHIP DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0096
Practice Address - Country:US
Practice Address - Phone:520-621-4622
Practice Address - Fax:520-621-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health