NPIMap

Organization Active NPI

Codac Behavioral Health Services of Pima County, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Tucson, AZ
National Provider Identifier
1902092166
Registry record updated Feb 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
BH-2093 Issued in AZ
Legal business name
CODAC BEHAVIORAL HEALTH SERVICES OF PIMA COUNTY, INC.
Practice address
160 W Fort Lowell Rd
Tucson, AZ 85705-3812
Phone
(520) 318-3266
Fax
(520) 318-0821
NPI assigned
Sep 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2008

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

Authorized official

Name
Mr. W Mark Clark
Title
Ceo
Phone
(520) 327-4505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X BH-2093 AZ Primary

Addresses

Primary practice location

160 W Fort Lowell Rd
Tucson, AZ 85705-3812

Mailing address

127 S 5TH Ave
Tucson, AZ 85701-2005
Phone (520) 327-4505

Other identifiers 1

IdentifierTypeStateIssuer
278824MedicaidAZ

Other names 1

  • Children & Adolescent Services (CAS) Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426001693 AZ Part B Supplier - Clinic/Group Practice 6103813811 Receives reassigned benefits from 48 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory

Locations

160 W Fort Lowell Rd
Tucson, AZ 85705
Phone (520) 318-3266

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1902092166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 S 5TH AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857012005",
            "telephone_number": "520-327-4505",
            "fax_number": "520-202-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 W FORT LOWELL RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857053812",
            "telephone_number": "520-318-3266",
            "fax_number": "520-318-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC BEHAVIORAL HEALTH SERVICES OF PIMA COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2008-02-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "W",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-327-4505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "AZ",
            "license": "BH-2093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278824",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children & Adolescent Services (CAS)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.