MEDICARE: EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER

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	261QB0400X	Birthing Clinic/Center	OTC5028	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336529031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER

Provider Business Mailing Address
First Line	:	839 W CONGRESS ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2819
Country	:	US
Telephone Number	:	520-670-3857
Fax Number	:

Provider Business Practice Location Address
First Line	:	5979 E GRANT RD STE 107
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2368
Country	:	US
Telephone Number	:	520-670-3705
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CELIA HIGHTOWER
Credential	:
Telephone Number	:	520-670-3705

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/12/2015

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