MEDICARE: SAMUEL UWIMANA

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	171W00000X	Contractor	BH9753	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH9753	OTHER	AZ	ARIZONA DEPT OF HEALTH SERVICES

General Provider Information

NPI Number	:	1508612623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL UWIMANA

Provider Business Mailing Address
First Line	:	PO BOX 86537
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85754-6537
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:	520-721-0069

Provider Business Practice Location Address
First Line	:	5985 S TAPPEN DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-0007
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:	520-721-0069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	04/29/2024

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Directions to “ SAMUEL UWIMANA ” Practice Location

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