Elizabeth E Wack MD PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

14736 Issued in AZ

Legal business name

ELIZABETH E WACK MD PC

Practice address

2055 W Hospital Dr
Suite 175
Tucson, AZ 85704

Phone

(520) 575-6944

Fax

(520) 575-1115

NPI assigned

Mar 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth E Wack, MD

Title

Chairman of the Board

Phone

(520) 575-6944

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073647251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 W HOSPITAL DR",
            "address_2": "SUITE 175",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85704",
            "telephone_number": "520-575-6944",
            "fax_number": "520-575-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 W HOSPITAL DR",
            "address_2": "SUITE 175",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85704",
            "telephone_number": "520-575-6944",
            "fax_number": "520-575-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH E WACK MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WACK",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "520-575-6944",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": "14736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266446",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.