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NPI Code Detail

MEDICARE: PINE BLUFF IUP, LLC

MEDICARE: PINE BLUFF IUP, LLC
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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1598600264
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINE BLUFF IUP, LLC
Provider Business Mailing Address
First Line : 6339 E SPEEDWAY BLVD STE 201
Second Line :
City : TUCSON
State : AZ
Zip : 85710-1147
Country : US
Telephone Number : 520-547-4115
Fax Number :
Provider Business Practice Location Address
First Line : 6339 E SPEEDWAY BLVD STE 201
Second Line :
City : TUCSON
State : AZ
Zip : 85710-1147
Country : US
Telephone Number : 520-547-4115
Fax Number :
Authorized Official
Title or Position : EA
Name : NILSA LOPES
Credential :
Telephone Number : 520-547-4115
Provider Enumeration Date : 04/21/2026
Last Update Date : 04/21/2026

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Directions to “PINE BLUFF IUP, LLC ” Practice Location

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