1437305091 NPI number — EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, 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 1437305091 NPI number — EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, 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:
LABORATORY EL RIO HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1437305091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
839 W CONGRESS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85745-2819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-670-3706
Provider Business Mailing Address Fax Number:
520-670-3792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 W PASEO REDONDO # 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85701-8274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-670-3706
Provider Business Practice Location Address Fax Number:
520-670-3792
Provider Enumeration Date:
08/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CRUCE
Authorized Official First Name:
CECILIA
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
520-309-2718

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  03D0641987 , 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)

  • Identifier: 399106 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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