Healthcare Provider Details

I. General information

NPI: 1497821698
Provider Name (Legal Business Name): HEALTHCARE SOUTHWEST. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 S 4TH AVE
TUCSON AZ
85713-3509
US

IV. Provider business mailing address

2016 S 4TH AVE
TUCSON AZ
85713-3509
US

V. Phone/Fax

Practice location:
  • Phone: 520-882-4252
  • Fax: 520-792-2835
Mailing address:
  • Phone: 520-882-4252
  • Fax: 520-792-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number11382
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11382
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number11382
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number11382
License Number StateAZ

VIII. Authorized Official

Name: DAVID A RUBEN
Title or Position: OWNER
Credential: M.D.
Phone: 520-882-4252