NPIMap

Organization Active NPI

San Luis Walk-in Clinic, Inc.

Doing business as San Luis Outpatient Surgery Center

  • Ambulatory Surgical Clinic/Center
  • San Luis, AZ
National Provider Identifier
1114549987
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SAN LUIS WALK-IN CLINIC, INC.
Doing business as
San Luis Outpatient Surgery Center
Practice address
151 S Oak Ave Ste 6
San Luis, AZ 85336-0756
Phone
(928) 315-7910
Fax
(928) 722-6113
NPI assigned
May 14, 2020
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, RD
Title
President & Ceo
Phone
(928) 315-7910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

151 S Oak Ave Ste 6
San Luis, AZ 85336-0756

Mailing address

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

Other names 1

  • San Luis Outpatient Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210311001299 AZ Part B Supplier - Ambulatory Surgical Center 2668361841 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: San Luis, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114549987. Details of each certification follow.

Ambulatory surgical center certification: CCN 03C0001448

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SAN LUIS OUTPATIENT SURGERY CENTER
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Feb 18, 2022
Last certification
Feb 18, 2022
Ownership / control type
Non-Profit
Facility address
151 South Oak Ave, Suite 6
San Luis, AZ 85336

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
San Luis Walk-in Clinic Inc20 organizations share this tax ID, including this one
Part of
San Luis Walk-in Clinic Inc

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

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 8

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": "1589414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1114549987",
    "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": "151 S OAK AVE STE 6",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853360756",
            "telephone_number": "928-315-7910",
            "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": "2020-05-14",
        "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": "RD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Luis Outpatient Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Luis, AZ

Sources for this page

Verify at the official NPI Registry.