NPIMap

Organization Active NPI

San Luis Walk-in Clinic, Inc.

  • Rural Health Clinic/Center
  • San Luis, AZ
National Provider Identifier
1104228337
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 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
Last updated
Sep 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN LUIS WALK-IN CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

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

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

Specialties & licenses 2

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

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 2

IdentifierTypeStateIssuer
943681MedicaidAZ
OTC3530OtherAZADHS LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

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

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Part of
San Luis Walk-in Clinic Inc

Ownership & related parties

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 IncSan Luis, AZ, CCN 033831 Rural health clinic Operational/Managerial Control (100%) May 1, 2003

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 88

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.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1104228337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 617",
            "city": "SOMERTON",
            "state": "AZ",
            "postal_code": "853500617",
            "telephone_number": "928-315-7910",
            "fax_number": "928-722-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1896 E BABBIT LN",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853367820",
            "telephone_number": "928-722-6112",
            "fax_number": "928-722-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "enumeration_date": "2014-09-18",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "AGUIRRE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "928-315-7910",
        "authorized_official_credential": "R.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "943681",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS LICENSE",
            "identifier": "OTC3530",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis, AZ

Sources for this page

Verify at the official NPI Registry.