Healthcare Provider Details

I. General information

NPI: 1932636123
Provider Name (Legal Business Name): TUCSON DIGESTIVE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7566 N LA CHOLLA BLVD STE B
TUCSON AZ
85741
US

IV. Provider business mailing address

7566 N LA CHOLLA BLVD STE B
TUCSON AZ
85741-6491
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-4139
  • Fax: 520-742-0814
Mailing address:
  • Phone: 520-547-5847
  • Fax:

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: ERIC BOON
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269