Provider Demographics
NPI:1588959027
Name:TANNACO CORPORATION
Entity type:Organization
Organization Name:TANNACO CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNATT-BIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-620-1810
Mailing Address - Street 1:PO BOX 32061
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-2061
Mailing Address - Country:US
Mailing Address - Phone:602-620-1810
Mailing Address - Fax:
Practice Address - Street 1:6122 N 7TH ST STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1858
Practice Address - Country:US
Practice Address - Phone:602-620-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ076430332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies