=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194917492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATALINA GASTROENTEROLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2007
-----------------------------------------------------
Last Update Date | 08/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1845 W ORANGE GROVE RD #125
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85704-1134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-297-3911
-----------------------------------------------------
Fax | 520-297-3955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 36205
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85740-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-297-3911
-----------------------------------------------------
Fax | 520-297-3955
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MR. CHRIS W. COLLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 520-297-3911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | AZ31258
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------