Healthcare Provider Details

I. General information

NPI: 1649596941
Provider Name (Legal Business Name): CATALINA EAR, NOSE & THROAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 E SHEA BLVD SUITE 100
SCOTTSDALE AZ
85260-6715
US

IV. Provider business mailing address

5910 N LA CHOLLA BLVD
TUCSON AZ
85741-3535
US

V. Phone/Fax

Practice location:
  • Phone: 623-432-8880
  • Fax: 623-240-1042
Mailing address:
  • Phone: 520-498-1800
  • Fax: 520-498-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY K WILLIAMS
Title or Position: CONTRACTING AND CREDENTIALING
Credential:
Phone: 520-990-4616