MEDICARE: MARANA 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)		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	329592	OTHER	AZ	AHCCCS GROUP NUMBER

General Provider Information

NPI Number	:	1730248972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARANA HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-3777
Fax Number	:	520-682-2333

Provider Business Practice Location Address
First Line	:	12635 W RUDASILL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-9724
Country	:	US
Telephone Number	:	520-682-3777
Fax Number	:	520-682-2333

Authorized Official
Title or Position	:	CEO
Name	:	JOSHUA B CARZOLI
Credential	:	PHARMD
Telephone Number	:	520-682-4111

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	05/06/2024

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