MEDICARE: WEST AJO MEDICAL CENTER LTD.

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	207Q00000X	Family Medicine Physician	1951	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10458	OTHER	AZ	PACIFICARE
2	1992894380	OTHER	AZ	UNITED HEALTH CARE
3	AZ0060530	OTHER	AZ	BLUE CROSS/BLUE SHIELD
4	0004660256	OTHER	AZ	AETNA

General Provider Information

NPI Number	:	1124326558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST AJO MEDICAL CENTER LTD.

Provider Business Mailing Address
First Line	:	101 W AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-6036
Country	:	US
Telephone Number	:	520-573-0993
Fax Number	:	520-573-0440

Provider Business Practice Location Address
First Line	:	101 W AJO WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-6036
Country	:	US
Telephone Number	:	520-573-0993
Fax Number	:	520-573-0440

Authorized Official
Title or Position	:	OWNER/SOLE PROPRIETOR
Name	:	DR. ALBERT ROBERT FRITZ III
Credential	:	D.O.
Telephone Number	:	520-573-0993

Provider Enumeration Date	:	03/09/2011
Last Update Date	:	03/09/2011

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Directions to “WEST AJO MEDICAL CENTER LTD. ” Practice Location

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