MEDICARE: THE UNIVERISTY OF ARIZONA

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	282N00000X	General Acute Care Hospital	R74017	AZ

General Provider Information

NPI Number	:	1952740151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE UNIVERISTY OF ARIZONA

Provider Business Mailing Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:	ROOM 4334 D PO BOX 245058
City	:	TUCSON
State	:	AZ
Zip	:	85724-5058
Country	:	US
Telephone Number	:	520-989-1420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:	ROOM 4334 D
City	:	TUCSON
State	:	AZ
Zip	:	85724-5058
Country	:	US
Telephone Number	:	520-989-1420
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM CORDINATOR
Name	:	JENNE SUMMERFIELD
Credential	:	BA
Telephone Number	:	520-626-7747

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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