MEDICARE: ARIZONA SKIN CANCER SURGERY CENTER, P.C.

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-3599	AZ

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	:	1518969773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA SKIN CANCER SURGERY CENTER, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 37075
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85740-7075
Country	:	US
Telephone Number	:	520-887-3333
Fax Number	:	520-887-3344

Provider Business Practice Location Address
First Line	:	5980 N LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3535
Country	:	US
Telephone Number	:	520-887-3333
Fax Number	:	520-887-3344

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	MICHAEL J. HUETHER
Credential	:	M.D.
Telephone Number	:	520-887-3333

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	10/06/2022

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