Healthcare Provider Details

I. General information

NPI: 1023015989
Provider Name (Legal Business Name): TUCSON GASTROENTEROLOGY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 N. SWAN ROAD STE. A
TUCSON AZ
85712
US

IV. Provider business mailing address

3040 N. SWAN ROAD STE. A
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-3454
  • Fax: 520-795-4492
Mailing address:
  • Phone: 520-327-3454
  • Fax: 520-795-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC-2781
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN J. MCNERNEY JR.
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 520-327-3454