PARK WAVERLY HEALTHCARE LLC (NPI# 1003470634) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003470634 |
| Entity Type | Organization |
| Organization Name | PARK WAVERLY HEALTHCARE LLC |
| Practice Address |
2001 N Park Ave Tucson AZ 85719-3558 |
| Practice Telephone | 5208826151 |
| Practice Fax Number | 5206201547 |
| Mailing Telephone | 5208826151 |
| Mailing Fax Number | 5206201547 |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2019-04-29 |
| Authorized Official Name | SOON BURNAM (TREASURER) |
| Authorized Official Telephone | 9495401249 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0401X |
Clinic/Center Specialization: Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | AZ DEPARTMENT OF HEALTH SERVICES | OTC9390 | 01 |
| Other Name | Type Code |
|---|---|
| Park Avenue Health and Rehabilitation Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629079975 | Park Waverly Healthcare LLC | Skilled Nursing Facility | 2001 North Park Avenue, Tucson, AZ 85719-3558 | 2005-08-09 |
| Street Address |
2001 N PARK AVE |
| City | TUCSON |
| State | AZ |
| Zip Code | 85719-3558 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528411170 | Carrie E Scott | Nurse Practitioner | 2001 N Park Ave, Tucson, AZ 85719-3558 | 2016-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649813635 | Ishani Ravindra Deo | Psychologist | 1051 E Mabel St, Tucson, AZ 85719 | 2019-10-22 |
| 1235793100 | Jacquelyn Christine Wagner | Pediatrics | 1625 N Campbell, Tucson, AZ 85719 | 2019-04-26 |
| 1831652189 | Derek Allan Hatfield | Emergency Medicine | 1625 N Campbell Ave., Tucson, AZ 85719 | 2019-04-12 |
| 1053874305 | Travis Patrick Martin | Emergency Medicine | 1625 N. Campbell Ave, Tucson, AZ 85719 | 2019-04-12 |
| 1245793504 | Martin Cisneroz | Emergency Medicine | 1625 North Campbell Avenue, Tucson, AZ 85719 | 2019-04-12 |
| 1174086722 | Sarah Joy Ring | Emergency Medicine | 1625 N. Campbell Ave., Tucson, AZ 85719 | 2019-04-10 |
| 1790245520 | Akash M Doshi | Student in an Organized Health Care Education/Training Program | 3838 N Campbell Avenue, Bldg 2, Tuscon, AZ 85719 | 2019-03-20 |
| 1942773668 | Jeffery Roy Small | Massage Therapist | 3607 N Vine, Tucson, AZ 85719 | 2019-01-04 |
| 1114434180 | Elizabeth Irene Welch | Behavioral Analyst | 1430 E Fort Lowell Rd Ste 100, Tucson, AZ 85719 | 2017-12-29 |
| 1477076255 | Medavail Pharmacy Inc. | Pharmacy | 1430 E Fort Lowell Rd Ste 120, Tucson, AZ 85719 | 2017-07-24 |
| Find all providers in zip 85719 | ||||
| Taxonomy Code | 261QR0401X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Definition to come... |
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|---|---|---|---|---|
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.