MEDICARE: ACACIA FAMILY MEDICINE, PC

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	261Q00000X	Clinic/Center	25298	AZ

General Provider Information

NPI Number	:	1033275938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACACIA FAMILY MEDICINE, PC

Provider Business Mailing Address
First Line	:	PO BOX 43130
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85733-3130
Country	:	US
Telephone Number	:	520-722-3777
Fax Number	:	520-296-6224

Provider Business Practice Location Address
First Line	:	3801 N CAMPBELL AVE
Second Line	:	SUITE B
City	:	TUCSON
State	:	AZ
Zip	:	85719-1448
Country	:	US
Telephone Number	:	520-732-3361
Fax Number	:	520-323-3618

Authorized Official
Title or Position	:	OWNER
Name	:	SHANTI R MARTINEZ-AKSAMIT
Credential	:	MD
Telephone Number	:	520-323-3617

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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