MEDICARE: TON SANTA ROSA HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center		AZ
2	261QP0904X	Federal Public Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0109850	OTHER	AZ	BC/BS AZ DENTAL PROV NO
2	03D0864300	OTHER	AZ	CLIA #
3	1770581639	OTHER	AZ	FACILITY PROVIDER #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0327177	OTHER	AZ	NACADP#
6	AZ0490080	OTHER	AZ	BC/BS AZ PROV NO

General Provider Information

NPI Number	:	1770581639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TON SANTA ROSA HEALTH CENTER

Provider Business Mailing Address
First Line	:	7900 S J STOCK RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-7012
Country	:	US
Telephone Number	:	520-547-8140
Fax Number	:

Provider Business Practice Location Address
First Line	:	FEDERAL ROUTE 15, MILEPOST 12
Second Line	:
City	:	SELLS
State	:	AZ
Zip	:	85634
Country	:	US
Telephone Number	:	520-361-2403
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. VERONICA GERONIMO
Credential	:
Telephone Number	:	520-547-8140

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	11/15/2024

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Directions to “TON SANTA ROSA HEALTH CENTER ” Practice Location

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