MEDICARE: CARONDELET HEALTH NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	OTH-4226	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OTH-4226	OTHER	AZ	AZ STATE LICENSE

General Provider Information

NPI Number	:	1114110053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARONDELET HEALTH NETWORK

Provider Business Mailing Address
First Line	:	2202 NORTH FORBES BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-1412
Country	:	US
Telephone Number	:	520-872-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	8290 SOUTH HOUGHTON ROAD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-9702
Country	:	US
Telephone Number	:	520-872-7700
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFIER
Name	:	MR. TOM R PEPPING
Credential	:	CFO
Telephone Number	:	520-872-7790

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	03/14/2008

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Directions to “CARONDELET HEALTH NETWORK ” Practice Location

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