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1500 W Commerce Ct Bldg 01, 02 Tucson AZ 85746-6015 | |
(520) 806-2650 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1500 W Commerce Ct, Tucson, Arizona |
Authorized Official Name and Position | Nancy Johnson (CEO) |
Authorized Official Contact | 5203092012 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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839 W Congress St Tucson AZ 85745-2819 Ph: (520) 806-2650 | 1500 W Commerce Ct Bldg 01, 02 Tucson AZ 85746-6015 Ph: (520) 806-2650 |
NPI Number | 1750672929 |
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Provider Enumeration Date | 04/22/2011 |
Last Update Date | 07/20/2016 |
Medicare PECOS PAC ID | 6305739244 |
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Medicare Enrollment ID | O20111004000190 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750672929 | NPI | - | NPPES |
947949 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | OTC0788 (Arizona) | Primary |
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