MARIPOSA COMMUNITY HEALTH CENTER INC NPI 1003837618

NPI Information

NPI: 1003837618
Provider Name: MARIPOSA COMMUNITY HEALTH CENTER, INC

Doing Business As: FAMILY HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 03D0531942

Address:
101 TAYLOR STREET
PATAGONIA, AZ
ZIP 85624
Phone: (520) 394-2262
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MARIPOSA COMMUNITY HEALTH CENTER, INC is a federally qualified health center (fqhc) clinic center in Patagonia, AZ. MARIPOSA COMMUNITY HEALTH CENTER, INC NPI is 1003837618. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Family Health Center.

The provider's business location address is:

101 TAYLOR STREET
PATAGONIA, AZ
ZIP 85624-645
Phone: (520) 394-2262
Fax: (520) 394-2753

The provider's authorized official is Daniel Prevost .
The authorized official title is Chief Executive Officer and has the following contact phone number (520) 761-2128.

The CLIA number assigned to this NPI record is 03D0531942 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/21/2006 and was last updated on 1/11/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YM0800X	Counselor	Mental Health	No
2	1223D0001X	Dentist	Dental Public Health	No
3	163W00000X	Registered Nurse		No
4	164W00000X	Licensed Practical Nurse		No
5	207Q00000X	Family Medicine		No
6	207R00000X	Internal Medicine		No
7	207V00000X	Obstetrics & Gynecology		No
8	208000000X	Pediatrics		No
9	208D00000X	General Practice		No
10	363A00000X	Physician Assistant		No
11	363L00000X	Nurse Practitioner		No
12	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	031809	OTHER	ARIZONA	MEDICARE PART A GROUP #
2	ZFQ31809	OTHER	ARIZONA	MEDICARE PART B GROUP #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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