Active NPI
Russ Warner, LISAC
- Counselor
- Tucson, AZ
National Provider Identifier
1851533640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 1077
- Practice address
- 4735 N 1St Ave
Tucson, AZ 85718-5610 - Phone
- (520) 991-5561
- Fax
- (520) 888-7254
- NPI assigned
- Mar 25, 2009
- Last updated
- Mar 25, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 1077 | AZ | Primary |
Addresses
Primary practice location
4735 N 1St Ave
Tucson, AZ 85718-5610
Mailing address
4735 N 1St Ave
Tucson, AZ 85718-5610
Phone (520) 991-5561
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1077 | Other | AZ | LISAC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1077 | AZ | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237939200000",
"number": "1851533640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4735 N 1ST AVE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857185610",
"telephone_number": "520-991-5561",
"fax_number": "520-888-7254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4735 N 1ST AVE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857185610",
"telephone_number": "520-991-5561",
"fax_number": "520-888-7254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARNER",
"first_name": "RUSS",
"credential": "LISAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-03-25",
"last_updated": "2009-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AZ",
"license": "1077",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LISAC",
"identifier": "1077",
"state": "AZ"
}
],
"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 Mar 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.