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San Luis Walk-in Clinic, Inc.

Organization Active NPI Rural Health Clinic/Center · San Luis, AZ

NPI 1104228337 · NPPES record last updated Sep 7, 2023

Key facts

NPI
1104228337
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
SAN LUIS WALK-IN CLINIC, INC.
Practice address
1896 E Babbit LN
San Luis, AZ 85336-7820
Phone
(928) 722-6112
Fax
(928) 722-6113
NPI assigned
Sep 18, 2014
Organization subpart
Yes
Parent organization (as reported)
SAN LUIS WALK-IN CLINIC, INC.

Authorized official

Name
Amanda Aguirre, R.D. NPI 1942615760
Title
President & Ceo
Phone
(928) 315-7910

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 89

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 89

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AZ

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
San Luis Walk-in Clinic Inc
San Luis, AZ · CCN 033831		 Rural health clinic Operational/Managerial Control (100%) May 1, 2003

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040514000795 AZ Part B Supplier - Clinic/Group Practice 2668361841 Receives reassigned benefits from 88 practitioners
18 other NPIs on this enrollment
Practice locations: Somerton, AZ; Yuma, AZ; San Luis, AZ; Kingman, AZ; Parker, AZ; Lake Havasu City, AZ

National Provider Directory

Part of
San Luis Walk-in Clinic Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

1896 E Babbit LN
San Luis, AZ 85336-7820

Mailing address

PO Box 617
Somerton, AZ 85350-0617
Phone (928) 315-7910

Other identifiers

IdentifierTypeStateIssuer
943681MedicaidAZ
OTC3530OtherAZADHS LICENSE

Other providers in San Luis, AZ

All providers in San Luis, AZ · Rural Health Clinic/Center in Arizona

Sources for this page

Verify at the official NPI Registry.