NPIMap

Organization Active NPI

Gila Valley Clinic PC

  • Rural Health Clinic/Center
  • Safford, AZ
National Provider Identifier
1740767664
Registry record updated Sep 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GILA VALLEY CLINIC PC
Practice address
1680 S 20TH Ave
Safford, AZ 85546
Phone
(928) 428-1377
Fax
(928) 428-6903
NPI assigned
Jul 24, 2018
Organization subpart
Yes
Parent organization
GILA VALLEY CLINIC PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2018

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

Authorized official

Name
Donna S. Coca
Title
Business Manager
Phone
(928) 428-1377

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1680 S 20TH Ave
Safford, AZ 85546

Mailing address

1680 S 20TH Ave
Safford, AZ 85546-4011
Phone (928) 428-1377

Other identifiers 1

IdentifierTypeStateIssuer
121963MedicaidAZ

Other names 1

  • GILA VALLEY CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180807002623 AZ Part A Provider - Rural Health Clinic 4981680683 Practice locations: Safford, AZ

Rural health clinic certification: CCN 033839

Legal name
GILA VALLEY CLINIC PC
Doing business as
GILA VALLEY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 23, 2019
Last certification
May 24, 2022
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Sep 28, 1978 in AZ
Enrollment address
1680 S 20TH Ave
Safford, AZ 85546-4011

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Part of
Morris T Sandeno MD

Locations

1680 S 20th Ave
Safford, AZ 85546
Phone (928) 428-1377

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Richard F Keith Individual 5% Or Greater Direct Ownership InterestPresident Sep 13, 2010 20%
Corporate OfficerPresident Sep 13, 2010 20%
Corporate DirectorPresident Sep 13, 2010 20%
W-2 Managing EmployeePresident Sep 13, 2010 20%
Susan J Jones Individual 5% Or Greater Direct Ownership InterestTreasurer Jun 1, 1984 20%
Corporate OfficerTreasurer Jun 1, 1984
Corporate DirectorTreasurer Jun 1, 1984
W-2 Managing EmployeeTreasurer Jun 1, 1984
Paul Cluff Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2022 20%
Corporate OfficerOwner Jan 1, 2022 20%
Corporate Director Jan 1, 2022 20%
W-2 Managing Employee Nov 1, 2019 20%
Donna S Coca Individual W-2 Managing EmployeeBusiness Manageer Dec 1, 2000
Operational/Managerial ControlBusiness Manager Dec 1, 2000
Catherine H Romero Individual 5% Or Greater Direct Ownership InterestSecretary/Medical Director Aug 21, 2000 20%
Corporate OfficerSecretary/Medical Director Aug 21, 2000
Corporate DirectorSecretary/Medical Director Aug 21, 2000
W-2 Managing EmployeeSecretary/Medical Director Aug 21, 2000
Gail Guerrero Tucker Individual 5% Or Greater Direct Ownership InterestVice President Aug 15, 2005 20%
Corporate OfficerVice President Aug 15, 2005
Corporate DirectorVice President Aug 15, 2005
W-2 Managing EmployeeVice President Aug 15, 2005

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Gail D Guerrero-Tucker, M.D.
    • Family Medicine Physician
    • Safford, AZ
    • NPI 1972537298

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership
  • Susan J Jones, M.D.
    • Family Medicine Physician
    • Safford, AZ
    • NPI 1114945201

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership
  • Catherine H Romero, M.D.
    • Family Medicine Physician
    • Safford, AZ
    • NPI 1205854304

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536278400000",
    "number": "1740767664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 S 20TH AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464011",
            "telephone_number": "928-428-1377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 S 20TH AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "85546",
            "telephone_number": "928-428-1377",
            "fax_number": "928-428-6903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILA VALLEY CLINIC PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GILA VALLEY CLINIC PC",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-09-07",
        "status": "A",
        "authorized_official_last_name": "COCA",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "928-428-1377"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121963",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GILA VALLEY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GILA VALLEY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Safford, AZ

Sources for this page

Verify at the official NPI Registry.