NPIMap

Organization Active NPI

San Luis Walk-in Clinic, Inc.

  • Rural Health Clinic/Center
  • San Luis, AZ
National Provider Identifier
1861780231
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAN LUIS WALK-IN CLINIC, INC.
Practice address
1896 E Babbit LN
San Luis, AZ 85336-7820
Phone
(928) 722-6112
Fax
(928) 722-6113
NPI assigned
Jul 19, 2011
Last updated
Sep 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN LUIS WALK-IN CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

Name
Amanda Aguirre, RDNPI 1942615760
Title
President & Ceo
Phone
(928) 315-7910

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

1896 E Babbit LN
San Luis, AZ 85336-7820

Mailing address

PO Box 617
Somerton, AZ 85350-0617
Phone (928) 315-7910

Other identifiers 1

IdentifierTypeStateIssuer
OTC3905OtherAZADHS LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315000556 AZ Part A Provider - Rural Health Clinic 2668361841 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Luis, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861780231. Details of each certification follow.

Rural health clinic certification: CCN 033831

Legal name
SAN LUIS WALK-IN CLINIC INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 25, 2004
Last certification
Jul 12, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 1, 2003 in AZ
Enrollment address
1896 E Babbit LN
San Luis, AZ 85336-7820

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
San Luis Walk-in Clinic Inc20 organizations share this tax ID, including this one
Part of
San Luis Walk-in Clinic Inc

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Howie Jorajuria Individual Corporate DirectorBoard Member Jan 27, 2019
Candice L Orduno Individual Corporate DirectorBoard Member Feb 6, 2009
San Luis Walk-in Clinic Inc Organization, Somerton, AZ Holding company Operational/Managerial Control May 1, 2003 100%
Gertrudis Medina Individual Corporate DirectorBoard Member Jan 27, 2019
Elizabeth Carpenter Individual OtherTreasurer/Secretary May 26, 2022
Amanda Aguirre Individual Corporate OfficerPresident and Ceo May 1, 2003
Operational/Managerial ControlPresident and Ceo May 1, 2003
Victor Lozano Individual Corporate DirectorBoard Member Jan 27, 2011
Jason Bradley Individual Corporate DirectorBoard Member Apr 25, 2019
Marisol Penuelas Individual W-2 Managing EmployeeClinical Operations Director Jun 22, 2022
Juan M Guerrero Individual Corporate DirectorBoard Member Feb 24, 2016
Ryan Holt Individual OtherVice Chair Sep 30, 2021
Eraclio Arvizu Individual Corporate DirectorVice Chair Jan 27, 2019

Owners & managing parties with NPI records 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 1

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": "1311033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1861780231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 617",
            "city": "SOMERTON",
            "state": "AZ",
            "postal_code": "853500617",
            "telephone_number": "928-315-7910",
            "fax_number": "928-722-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1896 E BABBIT LN",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853367820",
            "telephone_number": "928-722-6112",
            "fax_number": "928-722-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "enumeration_date": "2011-07-19",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "AGUIRRE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "928-315-7910",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS LICENSE",
            "identifier": "OTC3905",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis, AZ

Sources for this page

Verify at the official NPI Registry.