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MARIPOSA COMMUNITY HEALTH CENTER INC NPI 1578922787


NPI Information

NPI: 1578922787
Provider Name: MARIPOSA COMMUNITY HEALTH CENTER, INC

Other Name: MARIPOSA TUBAC REGIONAL HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 03D2193912

Address:
2221 E FRONTAGE RD STE 101
BLDG G-STE 101/BLDG F-STE 104
TUBAC, AZ
ZIP 85646
Phone: (520) 281-1550
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MARIPOSA COMMUNITY HEALTH CENTER, INC is a federally qualified health center (fqhc) clinic center in Tubac, AZ. MARIPOSA COMMUNITY HEALTH CENTER, INC NPI is 1578922787. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Mariposa Tubac Regional Health Center.

The provider's business location address is:

2221 E FRONTAGE RD STE 101
BLDG G-STE 101/BLDG F-STE 104
TUBAC, AZ
ZIP 85646-997
Phone: (520) 281-1550
Fax: (520) 281-4487

The provider's authorized official is Daniel Prevost .
The authorized official title is Chief Executive Officer and has the following contact phone number (520) 761-2128.

The CLIA number assigned to this NPI record is 03D2193912 - community clinic with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 2/16/2016 and was last updated on 1/17/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsAP4918ARIZONANo
2208000000XPediatrics43414ARIZONANo
3208D00000XGeneral PracticeAP4918ARIZONANo
4208D00000XGeneral Practice43414ARIZONANo
5363L00000XNurse PractitionerAP4918ARIZONANo
6207Q00000XFamily MedicineAP4918ARIZONANo
7207Q00000XFamily Medicine43414ARIZONANo
8207R00000XInternal Medicine16163ARIZONANo
9207VG0400XObstetrics & GynecologyGynecologyAP4918ARIZONANo
10207VG0400XObstetrics & GynecologyGynecology43414ARIZONANo
11261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1156624MEDICAIDARIZONA
2ZFQ31812OTHERARIZONAMEDICARE PART B GROUP#

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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