Healthcare Provider Details

I. General information

NPI: 1013517333
Provider Name (Legal Business Name): AMG MEDICAL TUCSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 N LA CHOLLA BLVD STE 117
TUCSON AZ
85741-3589
US

IV. Provider business mailing address

6130 N LA CHOLLA BLVD STE 117
TUCSON AZ
85741-3589
US

V. Phone/Fax

Practice location:
  • Phone: 520-207-7434
  • Fax: 520-269-6897
Mailing address:
  • Phone: 520-207-7434
  • Fax: 520-269-6897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BACCHUS-MORRIS
Title or Position: MD / OWNER
Credential: MD
Phone: 520-207-7434