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General NPI Number Information
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NPI Number | 1508437385
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Entity Type | Organization
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Legal Business Name | SPEEDWAY SURGICAL SPECIALISTS, LLC
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 6442 E SPEEDWAY BLVD STE 152
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City | TUCSON
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State | AZ
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Zip | 85710-1134
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Country | US
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Telephone | 520-771-8175
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Fax | 520-771-9402
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Provider Business Mailing Address
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Address Line | 6442 E SPEEDWAY BLVD STE 152
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City | TUCSON
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State | AZ
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Zip | 85710-0013
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Country | US
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Telephone | 520-771-8175
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Fax | 520-771-9194
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | AMY NAMANNY
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Credential | PHARMD/MBA
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Telephone | 520-777-4090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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