Healthcare Provider Details

I. General information

NPI: 1336494533
Provider Name (Legal Business Name): MARANA HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 N WILMOT RD BLDG B
TUCSON AZ
85711-1714
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-290-1100
  • Fax: 520-290-8997
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-682-3817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY005423
License Number StateAZ

VIII. Authorized Official

Name: CLARENCE G VATNE
Title or Position: CEO
Credential:
Phone: 520-682-4111