Healthcare Provider Details

I. General information

NPI: 1508437385
Provider Name (Legal Business Name): SPEEDWAY SURGICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6442 E SPEEDWAY BLVD STE 152
TUCSON AZ
85710-1134
US

IV. Provider business mailing address

6442 E SPEEDWAY BLVD STE 152
TUCSON AZ
85710-0013
US

V. Phone/Fax

Practice location:
  • Phone: 520-771-8175
  • Fax: 520-771-9402
Mailing address:
  • Phone: 520-771-8175
  • Fax: 520-771-9194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY NAMANNY
Title or Position: BOARD MEMBER
Credential: PHARMD/MBA
Phone: 520-777-4090