NPIMap

Organization Active NPI

St Elizabeths Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Tucson, AZ
National Provider Identifier
1023409760
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC0037 Issued in AZ
Legal business name
ST ELIZABETHS HEALTH CENTER INC
Practice address
140 W Speedway Blvd
Ste #100
Tucson, AZ 85705-7686
Phone
(520) 628-7871
NPI assigned
Feb 17, 2015
Last updated
Dec 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mauricette Montredon
Title
Chief Executive Officer
Phone
(520) 628-7871

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC0037 AZ Primary

Addresses

Primary practice location

140 W Speedway Blvd
Ste #100
Tucson, AZ 85705-7686

Mailing address

140 W Speedway Blvd
Ste #100
Tucson, AZ 85705-7686
Phone (520) 628-7871

Other identifiers 1

IdentifierTypeStateIssuer
939173MedicaidAZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576022400000",
    "number": "1023409760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 W SPEEDWAY BLVD",
            "address_2": "STE #100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857057686",
            "telephone_number": "520-628-7871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 W SPEEDWAY BLVD",
            "address_2": "STE #100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857057686",
            "telephone_number": "520-628-7871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST ELIZABETHS HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-17",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A",
        "authorized_official_last_name": "MONTREDON",
        "authorized_official_first_name": "MAURICETTE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "520-628-7871"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC0037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "939173",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.