MEDICARE: TERRITORY, PLLC

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	2084P0800X	Psychiatry Physician

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	:	1144644527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRITORY, PLLC

Provider Business Mailing Address
First Line	:	1631 W INA RD STE 151
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1907
Country	:	US
Telephone Number	:	520-742-1833
Fax Number	:	520-742-7548

Provider Business Practice Location Address
First Line	:	1631 W INA RD STE 151
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1907
Country	:	US
Telephone Number	:	520-742-1833
Fax Number	:	520-742-7548

Authorized Official
Title or Position	:	MEMBER
Name	:	JEANETTE WENDT
Credential	:	M.D.
Telephone Number	:	520-742-1833

Provider Enumeration Date	:	02/06/2014
Last Update Date	:	07/21/2022

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Directions to “TERRITORY, PLLC ” Practice Location

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