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General NPI Number Information
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NPI Number | 1861544942
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Entity Type | Organization
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Legal Business Name | MARANA HEALTH CENTER INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 13395 N MARANA MAIN ST
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City | MARANA
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State | AZ
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Zip | 85653-7008
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Country | US
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Telephone | 520-682-1095
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Fax | 520-682-2196
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Provider Business Mailing Address
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Address Line | PO BOX 188
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City | MARANA
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State | AZ
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Zip | 85653-0188
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Country | US
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Telephone | 520-682-4560
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Fax | 520-682-3299
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Authorized Official
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Title or Position | CEO
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Name | CLINTON G KUNTZ
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Credential |
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Telephone | 520-682-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 4075
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License Number State | AZ
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