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NPI Code Detail

MEDICARE: EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC

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
1261QF0400XFederally Qualified Health Center (FQHC)OTC3498AZ

Other Identifiers

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

General Provider Information

NPI Number : 1932490109
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 : 520-670-3857
Fax Number :
Provider Business Practice Location Address
First Line : 225 W IRVINGTON RD
Second Line :
City : TUCSON
State : AZ
Zip : 85714-3054
Country : US
Telephone Number : 520-670-3857
Fax Number :
Authorized Official
Title or Position : CEO
Name : MRS. NANCY JOHNSON
Credential :
Telephone Number : 520-309-2012
Provider Enumeration Date : 04/22/2011
Last Update Date : 07/20/2016

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Directions to “EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC ” Practice Location

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