Healthcare Provider Details

I. General information

NPI: 1386833473
Provider Name (Legal Business Name): SOULISTIC MEDICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 05/24/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CALLE IGLESIA
TUBAC AZ
85646
US

IV. Provider business mailing address

PO BOX 1990
TUBAC AZ
85646-1990
US

V. Phone/Fax

Practice location:
  • Phone: 520-398-2333
  • Fax: 520-398-9524
Mailing address:
  • Phone: 520-398-2333
  • Fax: 520-398-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE J LILLY
Title or Position: CFO
Credential:
Phone: 520-398-2333