MEDICARE: TUCSON GASTROENTEROLOGY INSTITUTE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	OSC-2781	AZ
2	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023015989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCSON GASTROENTEROLOGY INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	3040 N. SWAN ROAD
Second Line	:	STE. A
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-327-3454
Fax Number	:	520-795-4492

Provider Business Practice Location Address
First Line	:	3040 N. SWAN ROAD
Second Line	:	STE. A
City	:	TUCSON
State	:	AZ
Zip	:	85712
Country	:	US
Telephone Number	:	520-327-3454
Fax Number	:	520-795-4492

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOHN J. MCNERNEY JR.
Credential	:	M.D.
Telephone Number	:	520-327-3454

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	07/15/2013

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