Healthcare Provider Details

I. General information

NPI: 1154014249
Provider Name (Legal Business Name): AMH SERIES II AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 W INA RD STE 111
TUCSON AZ
85741-2378
US

IV. Provider business mailing address

3005 W INA RD STE 111
TUCSON AZ
85741-2378
US

V. Phone/Fax

Practice location:
  • Phone: 480-613-4137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TEAH SMITH
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 901-205-3999