| Harrison994 | |
|
994 S Harrison Rd Tucson AZ 85748-6608 | |
| (520) 721-1887 | |
| (520) 721-0069 |
| Full Name | Harrison994 |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 994 S Harrison Rd, Tucson, Arizona |
| Authorized Official Name and Position | Rose Mary Lopez (PRESIDENT AND CEO) |
| Authorized Official Contact | 5207211887 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Harrison994 Po Box 86537 Tucson AZ 85754-6537 Ph: (520) 721-1887 | Harrison994 994 S Harrison Rd Tucson AZ 85748-6608 Ph: (520) 721-1887 |
| NPI Number | 1083846661 |
|---|---|
| Provider Enumeration Date | 08/17/2009 |
| Last Update Date | 10/09/2020 |
| Certification Date | 10/09/2020 |
| Medicare PECOS PAC ID | 5395023048 |
|---|---|
| Medicare Enrollment ID | O20161031002068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083846661 | NPI | - | NPPES |
| OTC5916 | Other | AZ | STATE LICENSE |
| 451145 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH3355 (Arizona) | Primary |
| Provider Name | Justine R Confino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881781847 PECOS PAC ID: 2062485675 Enrollment ID: I20040812001330 |
| Provider Name | John S Leipsic |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841281060 PECOS PAC ID: 5890961122 Enrollment ID: I20120106000832 |
| Provider Name | Ian Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417402280 PECOS PAC ID: 8820374911 Enrollment ID: I20170403002154 |
| Provider Name | Misty Mcgillem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467847822 PECOS PAC ID: 3870869654 Enrollment ID: I20171023001789 |
| Provider Name | Andrew R Dorsett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770070732 PECOS PAC ID: 5890049480 Enrollment ID: I20181119000484 |
| Provider Name | Loretta Rose Kramer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386700441 PECOS PAC ID: 2769720143 Enrollment ID: I20190209000095 |
| Provider Name | Kathleen D Friend |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023056322 PECOS PAC ID: 1355230087 Enrollment ID: I20191022003755 |
| Provider Name | Mary Stephenson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962512707 PECOS PAC ID: 5991755712 Enrollment ID: I20191104003241 |
| Provider Name | Joy-anne Simone James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205381498 PECOS PAC ID: 2567742380 Enrollment ID: I20240229003657 |
| Provider Name | Martin Romeo Tamou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114785953 PECOS PAC ID: 1456791748 Enrollment ID: I20240503001093 |
| Provider Name | Jovan Martiza Ramirez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144796152 PECOS PAC ID: 0446691489 Enrollment ID: I20240508003141 |
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