Organization
EVENTIDE MINITRIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD DANYFIELD (CEO)
(520) 850-4096
Entity
Organization
Contact information
Practice address
3003 S COUNTRY CLUB RD, SUITE 277, TUCSON, AZ 85713-4082
(520) 622-0525
Mailing address
3003 SOUTH COUNTRY CLUB RD., SUITE 277, TUCSON, AZ 85713
(520) 622-0525
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174400000X
SPECIALIST
AZ
Enumeration date
05/05/2009
Last updated
05/05/2009
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