MEDICARE: ARIZONA COMMUNITY GASTROENTEROLOGY, PLC

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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1457953994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA COMMUNITY GASTROENTEROLOGY, PLC

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	:	1625 W INA RD STE 123
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1975
Country	:	US
Telephone Number	:	520-447-1526
Fax Number	:	520-829-4602

Authorized Official
Title or Position	:	OWNER
Name	:	ANIS HANNA
Credential	:	MD
Telephone Number	:	520-447-1526

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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