Healthcare Provider Details

I. General information

NPI: 1003152117
Provider Name (Legal Business Name): ARIZONA EMERGENCY MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6561 E CARONDELET DR
TUCSON AZ
85710-2156
US

IV. Provider business mailing address

6561 E CARONDELET DR
TUCSON AZ
85710-2156
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-2597
  • Fax: 520-886-6639
Mailing address:
  • Phone: 520-886-2597
  • Fax: 520-886-6639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CAMERON G JAVID
Title or Position: MANAGER
Credential: MD
Phone: 520-886-2597