Provider Demographics
| NPI: | 1649722331 |
|---|---|
| Name: | TUCSON ORTHOPAEDIC INSTITUTE PROFESSIONAL CORPORATION |
| Entity type: | Organization |
| Organization Name: | TUCSON ORTHOPAEDIC INSTITUTE PROFESSIONAL CORPORATION |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | PAULA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | REGISTER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 520-784-6200 |
| Mailing Address - Street 1: | PO BOX 31630 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | TUCSON |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85751-1630 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 520-784-6200 |
| Mailing Address - Fax: | 520-784-6109 |
| Practice Address - Street 1: | 2404 E RIVER RD BLDG 1 |
| Practice Address - Street 2: | |
| Practice Address - City: | TUCSON |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85718-6520 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 520-784-6200 |
| Practice Address - Fax: | 520-784-6109 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | TUCSON ORTHOPAEDIC INSTITUTE PROFESSIONAL CORPORATION |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2016-10-27 |
| Last Update Date: | 2020-03-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| AZ | 208100000X, 213ES0103X, 213ES0131X, 225100000X, 225X00000X, 246ZC0007X, 363A00000X, 363AM0700X, 363AS0400X, 363L00000X, 207X00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
| No | 213ES0131X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 246ZC0007X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Surgical Assistant | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AZ | 333076 | Medicaid | |
| AZ | ZWMBCJ | Medicare PIN |
