NPIMap

Organization Active NPI

Mariposa Community Health Center, Inc

  • Pharmacy
  • Nogales, AZ
National Provider Identifier
1497738017
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
3164 Issued in AZ
Legal business name
MARIPOSA COMMUNITY HEALTH CENTER, INC
Practice address
1852 N Mastick Way
Nogales, AZ 85621-1063
Phone
(520) 377-5417
Fax
(520) 377-5419
NPI assigned
Nov 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Authorized official

Name
Amy Taylor
Title
Chief Executive Officer
Phone
(520) 761-2128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 3164 AZ Primary

Addresses

Primary practice location

1852 N Mastick Way
Nogales, AZ 85621-1063

Mailing address

825 N Grand Ave Ste 100
Nogales, AZ 85621-2385
Phone (520) 761-2128

Other identifiers 1

IdentifierTypeStateIssuer
486359MedicaidAZ

Other names 1

  • Mariposa Pharmacy Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240129003562 AZ Part B Supplier - Pharmacy 8123926326 1 other NPI on this enrollment
Practice locations: Nogales, AZ; Rio Rico, AZ

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mariposa Comm HLTH Ctr Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

1852 N Mastick Way
Nogales, AZ 85621

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mariposa Community Health Center IncNogales, AZ, CCN 031812 Federally qualified health center Operational/Managerial Control Oct 1, 1991
Mariposa Community Health Center IncNogales, AZ, CCN 031884 Federally qualified health center Operational/Managerial Control Jan 1, 1980
Mariposa Community Health Center IncRio Rico, AZ, CCN 031885 Federally qualified health center Operational/Managerial Control Jan 1, 2006
Family Health CenterPatagonia, AZ, CCN 031809 Federally qualified health center Operational/Managerial Control Oct 1, 1991
Mariposa Community Health Center IncTubac, AZ, CCN 031938 Federally qualified health center Operational/Managerial Control Feb 15, 2016
Mariposa Community Health Center IncNogales, AZ, CCN 031003 Federally qualified health center Operational/Managerial Control Nov 30, 2020
Maternal Child Health Center of ExcellenceNogales, AZ, CCN 031079 Federally qualified health center Operational/Managerial Control Jan 1, 1980

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739750400000",
    "number": "1497738017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N GRAND AVE STE 100",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856212385",
            "telephone_number": "520-761-2128",
            "fax_number": "520-281-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1852 N MASTICK WAY",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856211063",
            "telephone_number": "520-377-5417",
            "fax_number": "520-377-5419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIPOSA COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-29",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "520-761-2128"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AZ",
            "license": "3164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "486359",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mariposa Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Nogales, AZ

Sources for this page

Verify at the official NPI Registry.