Intrepid of the Grand Canyon, Inc.

Primary specialty

Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X

Legal business name

INTREPID OF THE GRAND CANYON, INC.

Practice address

1820 E River Rd Ste 110
Tucson, AZ 85718-6595

Phone

(520) 873-9302

NPI assigned

Aug 5, 2021

Organization subpart

No

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

Authorized official

Name

Robert Parker, CCO

Title

Chief Compliance Officer

Phone

(214) 445-3750

Specialties & licenses 1

Addresses

Other names 1

• Intrepid Palliative & Supportive Care Doing business as

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

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1366116014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 KELLER SPRINGS RD STE 108",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750065911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 E RIVER RD STE 110",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857186595",
            "telephone_number": "520-873-9302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTREPID OF THE GRAND CANYON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "214-445-3750",
        "authorized_official_credential": "CCO"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intrepid Palliative & Supportive Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Tucson, AZ
• Hospice and Palliative Medicine (Family Medicine) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; 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.