Healthcare Provider Details

I. General information

NPI: 1629497474
Provider Name (Legal Business Name): MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 07/15/2024
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CENTRAL AVE STE 204
PHOENIX AZ
85004-1844
US

IV. Provider business mailing address

PO BOX 29670
PHOENIX AZ
85038-9670
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-8180
  • Fax: 602-344-8122
Mailing address:
  • Phone: 602-344-8180
  • Fax: 602-344-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH3673
License Number StateAZ

VIII. Authorized Official

Name: PAM FOWLER
Title or Position: SYSTEM DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 602-344-2830