Healthcare Provider Details

I. General information

NPI: 1699384040
Provider Name (Legal Business Name): THOMAS REICHENBACHER, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 N ORACLE RD STE 110
TUCSON AZ
85704-5604
US

IV. Provider business mailing address

6650 N ORACLE RD STE 110
TUCSON AZ
85704-5604
US

V. Phone/Fax

Practice location:
  • Phone: 520-639-8746
  • Fax: 520-900-7256
Mailing address:
  • Phone: 520-639-8746
  • Fax: 520-900-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1225119746
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerTYPE 1 NPI

VIII. Authorized Official

Name: THOMAS M REICHENBACHER
Title or Position: PROVIDER/OWNER
Credential:
Phone: 520-639-8746