=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891864153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIMA COUNTY AMPHITHEATER SCHOOLS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 03/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 WEST WETMORE ROAD ATTN STUDENT SERVICES
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85705-1547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-696-5095
-----------------------------------------------------
Fax | 520-696-5067
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 WEST WETMORE ROAD ATTN STUDENT SERVICES
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85705-1547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-696-5095
-----------------------------------------------------
Fax | 520-696-5067
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT DIRECTOR SPECIAL EDUCATIO
-----------------------------------------------------
Name | MS. PAMELA FENSTAMAKER
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 520-696-5095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | CTDS100210000
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------