NPIMap

Organization Active NPI

San Luis Walk-in Clinic, Inc.

Doing business as San Luis Urgent Care

  • Urgent Care Clinic/Center
  • San Luis, AZ
National Provider Identifier
1144680455
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
OTC7730 Issued in AZ
Legal business name
SAN LUIS WALK-IN CLINIC, INC.
Doing business as
San Luis Urgent Care
Practice address
1233 N Main St Ste 1a
San Luis, AZ 85336-0663
Phone
(928) 550-5514
Fax
(928) 550-5160
NPI assigned
Feb 29, 2016
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
Urgent Care Clinic/Center 261QU0200X OTC7730 AZ Primary

Addresses

Primary practice location

1233 N Main St Ste 1a
San Luis, AZ 85336-0663

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
OTC7730OtherAZADHS LICENSE
439088MedicaidAZ

Other names 1

  • SAN LUIS URGENT CARE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

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
This NPI is an additional NPI on the enrollment
Practice locations: Somerton, AZ; Yuma, AZ; San Luis, AZ; Kingman, AZ; Parker, AZ; Lake Havasu City, AZ
O20180122002047 AZ Part A Provider - Rural Health Clinic 2668361841 Practice locations: San Luis, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144680455. Details of each certification follow.

Rural health clinic certification: CCN 033838

Legal name
SAN LUIS WALK-IN CLINIC INC
Doing business as
SAN LUIS URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 27, 2018
Last certification
Dec 7, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 2016 in AZ
Enrollment address
1233 N Main St
Ste 1a
San Luis, AZ 85349

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 disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Arturo Magana Individual Corporate DirectorTreasurer Jan 27, 2019
Howie Jorajuria Individual Corporate DirectorAssistant Secretary Jan 27, 2019
Candice L Orduno Individual Corporate DirectorChair Jul 1, 2017
Gertrudis Medina Individual Corporate DirectorSecretary Jan 27, 2019
Maria Elena Rodriguez Individual Corporate OfficerClinical Operating Officer Jul 1, 2016
W-2 Managing EmployeeClinical Operating Officer Jul 1, 2016
Christopher Nunez Individual Corporate DirectorBoard Member Jul 1, 2017
Amanda Aguirre Individual Corporate OfficerPresident & Ceo Jul 1, 2017
Victor Lozano Individual Corporate DirectorBoard Member Jul 1, 2017
Jason Bradley Individual Corporate DirectorBoard Member Apr 25, 2019
Juan M Guerrero Individual Corporate DirectorVice Chair Jul 1, 2017
Eraclio Arvizu Individual Corporate DirectorBoard Member Jan 27, 2019

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1456704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1144680455",
    "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": "1233 N MAIN ST STE 1A",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853360663",
            "telephone_number": "928-550-5514",
            "fax_number": "928-550-5160"
        }
    ],
    "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": "2016-02-29",
        "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": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "AZ",
            "license": "OTC7730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS LICENSE",
            "identifier": "OTC7730",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "439088",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN LUIS URGENT CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAN LUIS URGENT CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Luis, AZ

Sources for this page

Verify at the official NPI Registry.