MEDICARE: EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)	OTC 5028	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255518528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	839 W CONGRESS ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2819
Country	:	US
Telephone Number	:	520-795-9912
Fax Number	:	520-670-3792

Provider Business Practice Location Address
First Line	:	5979 E GRANT RD #107
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2368
Country	:	US
Telephone Number	:	520-795-9912
Fax Number	:	520-670-3792

Authorized Official
Title or Position	:	CEO
Name	:	MRS. NANCY JOHNSON
Credential	:
Telephone Number	:	520-309-2012

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	08/20/2016

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