NPIMap

Organization Active NPI

Marana Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Tucson, AZ
National Provider Identifier
1497032460
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
OTC5209 Issued in AZ
Legal business name
MARANA HEALTH CENTER, INC
Practice address
1670 W Ruthrauff Rd
Tucson, AZ 85705-1253
Phone
(520) 616-6797
Fax
(520) 616-6798
NPI assigned
Nov 4, 2011
Organization subpart
No

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC5209 AZ Primary
Federally Qualified Health Center (FQHC) 261QF0400X AZ

Addresses

Primary practice location

1670 W Ruthrauff Rd
Tucson, AZ 85705-1253

Mailing address

PO Box 188
Marana, AZ 85653-0188
Phone (520) 616-6797

Other identifiers 2

IdentifierTypeStateIssuer
928714MedicaidAZ
329592OtherAZAHCCCS GROUP NUMBER

Other names 1

  • Ellie Towne 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
O20120709000379 AZ Part A Provider - Federally Qualified Health Center (FQHC) 2365348091 Practice locations: Tucson, AZ

Federally qualified health center certification: CCN 031903

Legal name
MARANA HEALTH CENTER INC
Doing business as
ELLIE TOWNE HEALTH CENTER
Certification status
Terminated Voluntary: merger or closure, Aug 1, 2024
Provider type (POS)
Federally qualified health center
Participating since
Jul 12, 2012
Last certification
Jul 12, 2012
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Sep 19, 1985 in AZ
Enrollment address
1670 W Ruthrauff Rd
Tucson, AZ 85705-1253

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 Center Inc42 organizations share this tax ID, including this one

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 13

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 - Secretary Jul 10, 2023
John Decker Individual Corporate DirectorBoard Member Jul 25, 2016
Celina Stude Individual Corporate DirectorBoard Member 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 DirectorDirector - Board Member Sep 18, 2022
Anne Schmotzer Individual Corporate DirectorDirector - Board Member Jan 19, 2023
Charles Steven Sera Individual Corporate DirectorBoard Member Nov 9, 2021
Heidi Kurgat Individual W-2 Managing EmployeeDirector of Compliance and Risk Mar 26, 2024
Irene Gonzales Individual Corporate DirectorBoard Member Nov 9, 2021
Amanda Wiggins Individual Corporate DirectorDirector - Board Member Jul 5, 2022
Janice L Truitt Individual Corporate DirectorBoard Member Nov 9, 2021
Craig Reck Individual Corporate DirectorBoard Member Nov 9, 2021
Timothy L Brunenkant Individual Corporate DirectorBoard Member Jul 25, 2016

NPI Registry JSON

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

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714953600000",
    "number": "1497032460",
    "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": "520-616-6797",
            "fax_number": "520-616-6798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 W RUTHRAUFF RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857051253",
            "telephone_number": "520-616-6797",
            "fax_number": "520-616-6798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARANA HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-04",
        "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": "OTC5209",
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "928714",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS GROUP NUMBER",
            "identifier": "329592",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Towne Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.