Marana Health Center Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Marana, AZ
NPI 1164526471 · NPPES record last updated May 6, 2024
Key facts
- NPI
- 1164526471
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- OTC-0032 (AZ)
- Legal business name
- MARANA HEALTH CENTER INC
- Practice address
- 13395 N Marana Main St
Marana, AZ 85653-7008 - Phone
- (520) 682-4111
- Fax
- (520) 682-3817
- NPI assigned
- Sep 8, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MARANA HEALTH CENTER INC
Authorized official
- Name
- Joshua B Carzoli, PHARMD
- Title
- Ceo
- Phone
- (520) 682-4111
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 13
Corporate family (same tax ID) 41
Practitioners 114
-
Linda Chung Ahn, M.D.
-
Dinajawan Balderas, FNP-C
-
Corbin Ballam, DO
-
Kari Lynn Beichter, LPC
-
Ariana Bickerton, LPC
-
Danielle Emory Brower, D.O.
-
Brittany Brown, MSN, PMHNP-BC
-
Matthew Hansen Brown, LPC
-
Jennifer Mae Carlile, FNP-C
-
Gerardo Carlos, MD
-
Cathy P. Carpenter, M.D.
-
Amy Michell Castillo, DNP-PMHNP
-
Karina Chacon, FNP
-
Isabella Chamseddine, LPC
-
Rachel Alyssa Clare, APRN
-
Mary Ann Clendenin, LCSW
-
Douglas G Cook, FNP
-
Sharon Davis, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ
Federally qualified health center certification: CCN 031837
- Legal name
- MARANA HEALTH CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 12, 2002
- Last certification
- Nov 12, 2002
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 1, 1964 in AZ
- Enrollment address
- 13395 N Marana Main St
Marana, AZ 85653-7008
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Edward Sicurello |
Corporate Director |
Jul 10, 2023 | |
| John Decker |
Corporate Director |
Apr 1, 2017 | |
| Celina Stude |
Corporate Director |
Jun 7, 2021 | |
| Joshua Carzoli |
Corporate Officer |
Jan 26, 2023 | 90% |
| Operational/Managerial Control |
Jan 26, 2023 | 100% | |
| Nathan Bolt |
Corporate Director |
Sep 18, 2022 | |
| Anne Schmotzer |
Corporate Director |
Jan 19, 2023 | |
| Charles Steven Sera |
Corporate Director |
Jul 22, 2013 | |
| Heidi Kurgat |
Operational/Managerial Control |
Mar 26, 2024 | |
| Janice L Truitt |
Corporate Director |
Oct 23, 2017 | |
| Tanisha Quenette Green |
Corporate Director |
Apr 3, 2023 | |
| Craig Reck |
Corporate Director |
Feb 1, 2021 | |
| Charles Feller Lang |
Corporate Director |
Jul 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031211000790 | AZ | Part B Supplier - Clinic/Group Practice | 2365348091 |
Receives reassigned benefits from 165 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tucson, AZ; Oro Valley, AZ; Marana, AZ |
| O20100720000610 | AZ | Part a Provider - Federally Qualified Health Center (FQHC) | 2365348091 |
1 other NPI on this enrollment Practice locations: Marana, AZ |
National Provider Directory
- Tax ID family
- Marana Health Center Inc
- Part of
- Marana Health Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | OTC-0032 | AZ | Yes |
Addresses
Primary practice location
13395 N Marana Main St
Marana, AZ 85653-7008
Mailing address
PO Box 188
Marana, AZ 85653-0188
Phone (520) 682-4111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 329592 | Other | AZ | AHCCCS GROUP NUMBER |
| 929343 | Medicaid | AZ |
Other names
- Marana Health Center
Other providers in Marana, AZ
- Marana Behavioral Health Center
- Marana Chiropractic PLLC
- Marana Health Center
- Marana Health Center
- Marana Health Center
- Marana Health Center Inc
- Marana Health Center Inc
- Marana Health Center Inc
- Marana Health Center, Inc
- Marana Health Center, Inc
All providers in Marana, AZ · Federally Qualified Health Center (FQHC) in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.