Marana Health Center, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

OCT4381 Issued in AZ

Legal business name

MARANA HEALTH CENTER, INC

Doing business as

West Side Health Center

Practice address

2202 W Anklam Rd
Tucson, AZ 85709-0001

Phone

(520) 616-6790

Fax

(520) 622-0849

NPI assigned

May 16, 2008

Last updated

Feb 27, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

MARANA HEALTH CENTER, INCAs reported in NPPES

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

Authorized official

Name

Mr. Clinton Kuntz, CEO

Title

Ceo

Phone

(520) 682-4111

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• West Side Health Center Doing business as

Part of

Marana Community Clinic

Locations

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519689600000",
    "number": "1316104573",
    "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": "520-682-4111",
            "fax_number": "520-818-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 W ANKLAM RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857090001",
            "telephone_number": "520-616-6790",
            "fax_number": "520-622-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARANA HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARANA HEALTH CENTER, INC",
        "enumeration_date": "2008-05-16",
        "last_updated": "2018-02-27",
        "status": "A",
        "authorized_official_last_name": "KUNTZ",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-682-4111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OCT4381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS GROUP NUMBER",
            "identifier": "329592",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "928895",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Side Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Federally Qualified Health Center (FQHC) in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Federally Qualified Health Center (FQHC) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.