Basic Information
| Provider Information | |||||||||
| NPI: | 1285676643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PULMONARY ASSOCIATES OF SOUTHERN ARIZONA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1951 N WILMOT RD | ||||||||
| Address2: | BLDG 4 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857128000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203181114 | ||||||||
| FaxNumber: | 5203184693 | ||||||||
| Practice Location | |||||||||
| Address1: | 1951 N WILMOT RD | ||||||||
| Address2: | BLDG 4 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857128000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203181114 | ||||||||
| FaxNumber: | 5203184693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 10/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | ROTKIS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5203181114 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 207RP1001X | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 508236 | 05 | AZ | MEDICAID | 235707 | 05 | AZ | MEDICAID |