Provider Demographics
NPI:1871985366
Name:MEDICAL SERVICES OF SOUTHERN ARIZONA
Entity type:Organization
Organization Name:MEDICAL SERVICES OF SOUTHERN ARIZONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LE ROI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-886-1071
Mailing Address - Street 1:PO BOX 43160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3160
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:6365 E TANQUE VERDE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3830
Practice Address - Country:US
Practice Address - Phone:520-886-1071
Practice Address - Fax:520-881-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30154207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ001588Medicaid