Provider Demographics
NPI:1871542795
Name:UNIVERSITY MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:UNIVERSITY MEDICAL CENTER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-694-1125
Mailing Address - Street 1:655 E RIVER RD
Mailing Address - Street 2:SUITE B 209
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5840
Mailing Address - Country:US
Mailing Address - Phone:520-694-4663
Mailing Address - Fax:520-694-2560
Practice Address - Street 1:655 E RIVER RD
Practice Address - Street 2:SUITE B 209
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5840
Practice Address - Country:US
Practice Address - Phone:520-694-4663
Practice Address - Fax:520-694-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA- 0053251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ676182Medicaid
AZ037052Medicare Oscar/Certification