Healthcare Provider Details

I. General information

NPI: 1215926829
Provider Name (Legal Business Name): EL DORADO HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N WILMOT RD
TUCSON AZ
85712-4409
US

IV. Provider business mailing address

1400 N WILMOT RD
TUCSON AZ
85712-4409
US

V. Phone/Fax

Practice location:
  • Phone: 520-721-5116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberH-3500
License Number StateAZ

VIII. Authorized Official

Name: NATE TANPIENGCO
Title or Position: CORPORATE SR VP - CFO
Credential:
Phone: 520-324-1160