NPIMap

Organization Active NPI

Marana Health Center, Inc

Doing business as Wilmot Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Tucson, AZ
National Provider Identifier
1295986735
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC5399 Issued in AZ
Legal business name
MARANA HEALTH CENTER, INC
Doing business as
Wilmot Family Health Center
Practice address
899 N Wilmot Rd Ste B
Tucson, AZ 85711-1712
Phone
(520) 290-1100
Fax
(520) 290-8997
NPI assigned
Oct 2, 2008
Last updated
May 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MARANA HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Authorized official

Name
Joshua B Carzoli, PHARMD
Title
Ceo
Phone
(520) 682-4111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC5399 AZ Primary

Addresses

Primary practice location

899 N Wilmot Rd Ste B
Tucson, AZ 85711-1712

Mailing address

PO Box 188
Marana, AZ 85653-0188
Phone (520) 290-1100

Other names 1

  • Wilmot Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090429000223 AZ Part A Provider - Federally Qualified Health Center (FQHC) 2365348091 Practice locations: Tucson, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295986735. Details of each certification follow.

Federally qualified health center certification: CCN 031872

Legal name
MARANA HEALTH CENTER INC
Doing business as
WILMOT FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 29, 2009
Last certification
Apr 29, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 24, 1957 in AZ
Enrollment address
899 N Wilmot Rd
Ste B
Tucson, AZ 85711-1712

Other NPIs with the same Medicare PAC ID 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Marana Health Clinic42 organizations share this tax ID, including this one
Part of
Marana Health Clinic

Other organizations with this tax ID 41

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

View all 41

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Edward Sicurello Individual Corporate DirectorOfficer - Vice President Jul 10, 2023
John Decker Individual Corporate DirectorOfficer - President Jul 25, 2016
Celina Stude Individual Corporate OfficerOfficer - Secretary Nov 9, 2021
Joshua Carzoli Individual Corporate OfficerChief Executive Officer Jan 26, 2023 100%
Operational/Managerial ControlChief Executive Officer Jan 26, 2023 100%
Nathan Bolt Individual Corporate DirectorOfficer - Treasurer Sep 18, 2022
Anne Schmotzer Individual Corporate DirectorDirector - Board Member Jan 19, 2023
Charles Steven Sera Individual Corporate DirectorDirector - Board Member Nov 9, 2021
Heidi Kurgat Individual Operational/Managerial ControlDirector of Compliance and Risk Mar 26, 2024
Janice L Truitt Individual Corporate DirectorDirector - Board Member Nov 9, 2021
Tanisha Quenette Green Individual Corporate DirectorDirector - Board Member Apr 3, 2023
Craig Reck Individual Corporate DirectorBoard of Director - Member Nov 9, 2021
Charles Feller Lang Individual Corporate DirectorDirector - Board Member Jul 1, 2024

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1295986735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "MARANA",
            "state": "AZ",
            "postal_code": "856530188",
            "telephone_number": "520-290-1100",
            "fax_number": "520-290-8997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "899 N WILMOT RD STE B",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857111712",
            "telephone_number": "520-290-1100",
            "fax_number": "520-290-8997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARANA HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARANA HEALTH CENTER",
        "enumeration_date": "2008-10-02",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "CARZOLI",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-682-4111",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC5399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilmot Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.