NPIMap

Organization Active NPI

Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm

Doing business as San Lucy Clinic

  • Public Health or Welfare Agency
  • Gila Bend, AZ
National Provider Identifier
1962949008
Registry record updated Jun 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Doing business as
San Lucy Clinic
Practice address
1216 N. 307TH Avenue
San Lucy Clinic
Gila Bend, AZ 85337
Phone
(928) 683-2913
Fax
(928) 683-2008
NPI assigned
Jan 27, 2017
Last updated
Jun 19, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 19, 2019

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

Authorized official

Name
Miss Deanna J. Dick, MSW,. MHA
Title
(Ceo) Chief Executive Officer
Phone
(602) 263-1567

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X NU Primary

Addresses

Primary practice location

1216 N. 307TH Avenue
San Lucy Clinic
Gila Bend, AZ 85337

Mailing address

San Lucy Clinic
P.O.Box 31001-0698
Pasadena, CA 91110-0698
Phone (602) 263-1200

Other names 1

  • San Lucy Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000797 TX Part B Supplier - Clinic/Group Practice 1759290901 Receives reassigned benefits from 636 practitioners
25 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Camp Verde, AZ; Gila Bend, AZ; Maricopa, AZ; Phoenix, AZ

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Dhew Ind HTLH SV HLTH S18 organizations share this tax ID, including this one
Part of
Dhew Ind HTLH SV HLTH S

Other organizations with this tax ID 17

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

View all 17

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": "1485475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560902400000",
    "number": "1962949008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SAN LUCY CLINIC",
            "address_2": "P.O.BOX 31001-0698",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911100698",
            "telephone_number": "602-263-1200",
            "fax_number": "602-263-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 N. 307TH AVENUE",
            "address_2": "SAN LUCY CLINIC",
            "city": "GILA BEND",
            "state": "AZ",
            "postal_code": "85337",
            "telephone_number": "928-683-2913",
            "fax_number": "928-683-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM",
        "enumeration_date": "2017-01-27",
        "last_updated": "2019-06-19",
        "status": "A",
        "authorized_official_last_name": "DICK",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "(CEO) CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "602-263-1567",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MSW,. MHA"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Lucy Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gila Bend, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; 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.