| Intermountain Centers | |
|
401 N Bonita Ave Tucson AZ 85709-5001 | |
| (520) 571-6466 | |
| (520) 721-0069 |
| Full Name | Intermountain Centers |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 401 N Bonita Ave, Tucson, Arizona |
| Authorized Official Name and Position | Rose Mary Lopez (PRESIDENT AND CEO) |
| Authorized Official Contact | 5207211887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intermountain Centers Po Box 86537 Tucson AZ 85754-6537 Ph: (520) 721-1887 | Intermountain Centers 401 N Bonita Ave Tucson AZ 85709-5001 Ph: (520) 571-6466 |
| NPI Number | 1861042012 |
|---|---|
| Provider Enumeration Date | 09/18/2019 |
| Last Update Date | 04/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861042012 | NPI | - | NPPES |
| OTC9948 | Other | AZ | ADHS/BMFL LICENSE |
| 146445 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
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