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General NPI Number Information
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NPI Number | 1154389005
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Entity Type | Organization
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Legal Business Name | SPORT INSTITUTE OF TUCSON PC
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 6369 E TANQUE VERDE RD
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City | TUCSON
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State | AZ
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Zip | 85715-3850
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Country | US
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Telephone | 520-618-5500
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Fax | 520-618-5944
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Provider Business Mailing Address
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Address Line | 6369 E TANQUE VERDE RD
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City | TUCSON
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State | AZ
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Zip | 85715-3850
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Country | US
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Telephone | 520-618-5500
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Fax | 520-618-5944
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. TY HOWARD ENDEAN
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Credential | D.O.
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Telephone | 520-618-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3953
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License Number State | AZ
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