MEDICARE: TEEN OUTREACH PREGNANCY SERVICES

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	251300000X	Local Education Agency (LEA)	RN000099129	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	:	1932466356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEEN OUTREACH PREGNANCY SERVICES

Provider Business Mailing Address
First Line	:	3024 E FT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1572
Country	:	US
Telephone Number	:	520-888-2881
Fax Number	:	520-770-0035

Provider Business Practice Location Address
First Line	:	3024 E FT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1572
Country	:	US
Telephone Number	:	520-888-2881
Fax Number	:	520-770-0035

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LAURA ANN PEDERSEN
Credential	:	RN
Telephone Number	:	520-888-2881

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	04/23/2012

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