NPIMap

Organization Active NPI

Presidio Surgical Group, P.C.

  • Surgery Physician
  • Tucson, AZ
National Provider Identifier
1669426235
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
13209 Issued in AZ
Legal business name
PRESIDIO SURGICAL GROUP, P.C.
Practice address
1925 W Orange Grove Rd
Suite 101
Tucson, AZ 85704-1143
Phone
(520) 219-9125
Fax
(520) 219-9130
NPI assigned
May 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Willard Richard Carnahan, M.D.NPI 1285686311
Title
President
Phone
(520) 219-9125

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 13209 AZ Primary

Addresses

Primary practice location

1925 W Orange Grove Rd
Suite 101
Tucson, AZ 85704-1143

Mailing address

1925 W Orange Grove Rd
Suite 101
Tucson, AZ 85704-1143
Phone (520) 219-9125

National Provider Directory

National Provider Directory

Locations

1925 W Orange Grove Rd
Ste 101
Tucson, AZ 85704
Phone (520) 219-9125

2055 W Hospital Dr
Ste 295
Tucson, AZ 85704
Phone (520) 219-9125

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669426235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 W ORANGE GROVE RD",
            "address_2": "SUITE 101",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857041143",
            "telephone_number": "520-219-9125",
            "fax_number": "520-219-9130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 W ORANGE GROVE RD",
            "address_2": "SUITE 101",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857041143",
            "telephone_number": "520-219-9125",
            "fax_number": "520-219-9130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESIDIO SURGICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARNAHAN",
        "authorized_official_first_name": "WILLARD",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "520-219-9125",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "13209",
            "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 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.