MEDICARE: UNITED COMMUNITY HEALTH CENTER-MARIA AUXILIADORA, 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	261QM1300X	Multi-Specialty Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)	6491	AZ

General Provider Information

NPI Number	:	1972968360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED COMMUNITY HEALTH CENTER-MARIA AUXILIADORA, INC.

Provider Business Mailing Address
First Line	:	1260 S CAMPBELL AVE
Second Line	:	BLDG. 2
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-0503
Country	:	US
Telephone Number	:	520-407-5606
Fax Number	:	520-625-8504

Provider Business Practice Location Address
First Line	:	4475 S I 19 FRONTAGE RD
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85614-5884
Country	:	US
Telephone Number	:	520-407-5606
Fax Number	:	520-625-8504

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JON REARDON
Credential	:	MSW, MBA
Telephone Number	:	520-407-5609

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	06/20/2025

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