1174705180 NPI number — UNITED COMMUNITY HEALTH CENTER MARIA AUXILIADORA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174705180 NPI number — UNITED COMMUNITY HEALTH CENTER MARIA AUXILIADORA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED COMMUNITY HEALTH CENTER MARIA AUXILIADORA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174705180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1260 S CAMPBELL AVE
Provider Second Line Business Mailing Address:
BUILDING 2
Provider Business Mailing Address City Name:
GREEN VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85614-0503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-407-5600
Provider Business Mailing Address Fax Number:
520-625-8504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 WEST ARIVACA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMADO
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-407-5600
Provider Business Practice Location Address Fax Number:
520-625-8504
Provider Enumeration Date:
11/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JIMENEZ
Authorized Official First Name:
RODOLFO
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
520-407-5600

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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