Healthcare Provider Details

I. General information

NPI: 1861544942
Provider Name (Legal Business Name): MARANA HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13395 N MARANA MAIN ST
MARANA AZ
85653-7008
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-682-1095
  • Fax: 520-682-2196
Mailing address:
  • Phone: 520-682-4560
  • Fax: 520-682-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number4075
License Number StateAZ

VIII. Authorized Official

Name: CLINTON G KUNTZ
Title or Position: CEO
Credential:
Phone: 520-682-4111