Provider Demographics
NPI:1871570424
Name:ARIZONA DIGESTIVE INSTITUTE LLC
Entity type:Organization
Organization Name:ARIZONA DIGESTIVE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PH D
Authorized Official - Phone:520-742-4139
Mailing Address - Street 1:7566 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2307
Mailing Address - Country:US
Mailing Address - Phone:520-547-5847
Mailing Address - Fax:520-742-9618
Practice Address - Street 1:7566 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2307
Practice Address - Country:US
Practice Address - Phone:520-547-5847
Practice Address - Fax:520-742-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-26
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7686428OtherAETNA
AZIZ0160OtherHEALTHNET
AZAZ0208470OtherBLUE CROSS BLUE SHIELD
AR906555Medicaid
AZ906555Medicaid
AZP00013145Medicare ID - Type UnspecifiedRAIL ROAD
AZ906555Medicaid