Active NPI
Mary Ann Clark
- Clinic/Center
- Fort Huachuca, AZ
National Provider Identifier
1881126894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- 1-125268
- Practice address
- 2240 E Winrow Ave
Fort Huachuca, AZ 85613 - Phone
- (520) 533-3533
- NPI assigned
- Mar 29, 2017
- Last updated
- Mar 29, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 1-125268 | AL | Primary |
Addresses
Primary practice location
2240 E Winrow Ave
Fort Huachuca, AZ 85613
Mailing address
4571 Paseo Brazos
Sierra Vista, AZ 85635-2376
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1-125268 | Other | AL | ALABAMA BOARN OF NURSING LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-125268 | AL | MD | Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490745600000",
"number": "1881126894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4571 PASEO BRAZOS",
"city": "SIERRA VISTA",
"state": "AZ",
"postal_code": "856352376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2240 E WINROW AVE",
"city": "FORT HUACHUCA",
"state": "AZ",
"postal_code": "85613",
"telephone_number": "520-533-3533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MARY ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-29",
"last_updated": "2017-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "AL",
"license": "1-125268",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALABAMA BOARN OF NURSING LICENSE NUMBER",
"identifier": "1-125268",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Huachuca, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.