Organization Active NPI

Speedway Surgical Specialists, LLC

  • Ambulatory Surgical Clinic/Center
  • Tucson, AZ
National Provider Identifier
1508437385
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SPEEDWAY SURGICAL SPECIALISTS, LLC
Practice address
6442 E Speedway Blvd Ste 152
Tucson, AZ 85710-1134
Phone
(520) 771-8175
Fax
(520) 771-9402
NPI assigned
Jul 2, 2021
Organization subpart
Yes
Parent organization
SPEEDWAY SURGICAL SPECIALISTS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2023

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

Authorized official

Name
Amy Namanny, PHARMD/MBA
Title
Board Member
Phone
(520) 777-4090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

6442 E Speedway Blvd Ste 152
Tucson, AZ 85710-1134

Mailing address

6442 E Speedway Blvd Ste 152
Tucson, AZ 85710-0013
Phone (520) 771-8175

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220720000553 AZ Part B Supplier - Ambulatory Surgical Center 6709267925 Receives reassigned benefits from 1 practitioner
Practice locations: Tucson, AZ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2234140Speedway Surgical Specialists6442 E Speedway Blvd Ste 152, Tucson, AZ 85710Certificate of waiverAug 26, 2027

National Provider Directory

National Provider Directory
Part of
Speedway Surgical Specialists LLC

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1508437385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6442 E SPEEDWAY BLVD STE 152",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857100013",
            "telephone_number": "520-771-8175",
            "fax_number": "520-771-9194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6442 E SPEEDWAY BLVD STE 152",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857101134",
            "telephone_number": "520-771-8175",
            "fax_number": "520-771-9402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEEDWAY SURGICAL SPECIALISTS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPEEDWAY SURGICAL SPECIALISTS, LLC",
        "enumeration_date": "2021-07-02",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A",
        "authorized_official_last_name": "NAMANNY",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "520-777-4090",
        "authorized_official_credential": "PHARMD/MBA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.