NPIMap

Organization Active NPI

Intermountain Health Center Inc

  • Multi-Specialty Clinic/Center
  • Tucson, AZ
National Provider Identifier
1609245273
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
INTERMOUNTAIN HEALTH CENTER INC
Practice address
5055 E Broadway Blvd Ste C104
Tucson, AZ 85711-3641
Phone
(520) 628-9833
Fax
(520) 623-9083
NPI assigned
Sep 24, 2015
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Rose Mary Lopez, MBA
Title
President and Ceo
Phone
(520) 721-1887

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

5055 E Broadway Blvd Ste C104
Tucson, AZ 85711-3641

Mailing address

PO Box 86537
Tucson, AZ 85754-6537
Phone (520) 721-1887

Other identifiers 2

IdentifierTypeStateIssuer
198509MedicaidAZ
OTC7779OtherAZADHS/BMFL LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190722003187 AZ Part B Supplier - Clinic/Group Practice 7113253659 Receives reassigned benefits from 24 practitioners
5 other NPIs on this enrollment
Practice locations: Nogales, AZ; Casa Grande, AZ; Tucson, AZ

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2152330Intermountain Health Center, Inc5055 E Broadway Blvd Ste C104, Tucson, AZ 85711Certificate of waiverAug 6, 2026

National Provider Directory

National Provider Directory
Tax ID family
Ihc Broadway4 organizations share this tax ID, including this one
Part of
Intermountain Centers for Human Development Inc

Other organizations with this tax ID 3

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

Locations

2028 N Trekell Rd
Ste 102
Casa Grande, AZ 85122
Phone (520) 381-3010

5055 E Broadway Blvd
Tucson, AZ 85711
Phone (520) 547-2311

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1443052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1609245273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86537",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857546537",
            "telephone_number": "520-721-1887",
            "fax_number": "520-721-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5055 E BROADWAY BLVD STE C104",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857113641",
            "telephone_number": "520-628-9833",
            "fax_number": "520-623-9083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT",
        "enumeration_date": "2015-09-24",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "520-721-1887",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "198509",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS/BMFL LICENSE",
            "identifier": "OTC7779",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.