NPIMap

Organization Active NPI

Ice Health Service Corps

  • Federal Public Health Clinic/Center
  • Florence, AZ
National Provider Identifier
1841634201
Registry record updated Apr 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federal Public Health Clinic/CenterTaxonomy code 261QP0904X
License
0024169459 Issued in VA
Legal business name
ICE HEALTH SERVICE CORPS
Practice address
3250 N Pinal Pkwy
Florence, AZ 85132-9459
Phone
(520) 868-2049
Fax
(520) 868-1547
NPI assigned
Apr 28, 2013
Last updated
Apr 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2013

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

Authorized official

Name
Brent Stephen
Title
Health Service Administrator
Phone
(520) 868-8439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federal Public Health Clinic/Center 261QP0904X 0024169459 VA Primary

Addresses

Primary practice location

3250 N Pinal Pkwy
Florence, AZ 85132-9459

Mailing address

3250 N Pinal Pkwy
Florence, AZ 85132-9459
Phone (520) 868-2049

National Provider Directory

National Provider Directory
Tax ID family
Centers for Disease Control and Prevention US Public Health Service10 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

3250 N Pinal Pkwy
Florence, AZ 85132
Phone (520) 868-2049

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1367107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367107200000",
    "number": "1841634201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 N PINAL PKWY",
            "city": "FLORENCE",
            "state": "AZ",
            "postal_code": "851329459",
            "telephone_number": "520-868-2049",
            "fax_number": "520-868-1547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 N PINAL PKWY",
            "city": "FLORENCE",
            "state": "AZ",
            "postal_code": "851329459",
            "telephone_number": "520-868-2049",
            "fax_number": "520-868-1547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICE HEALTH SERVICE CORPS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-28",
        "last_updated": "2013-04-28",
        "status": "A",
        "authorized_official_last_name": "STEPHEN",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "HEALTH SERVICE ADMINISTRATOR",
        "authorized_official_telephone_number": "520-868-8439"
    },
    "taxonomies": [
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": "VA",
            "license": "0024169459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2013; 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.