Provider Demographics
NPI:1386833473
Name:SOULISTIC MEDICAL INSTITUTE
Entity Type:Organization
Organization Name:SOULISTIC MEDICAL INSTITUTE
Other - Org Name:SOULISTIC HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-398-2333
Mailing Address - Street 1:PO BOX 1990
Mailing Address - Street 2:
Mailing Address - City:TUBAC
Mailing Address - State:AZ
Mailing Address - Zip Code:85646-1990
Mailing Address - Country:US
Mailing Address - Phone:520-398-2333
Mailing Address - Fax:520-398-2944
Practice Address - Street 1:18 CALLE IGLESIA
Practice Address - Street 2:
Practice Address - City:TUBAC
Practice Address - State:AZ
Practice Address - Zip Code:85646
Practice Address - Country:US
Practice Address - Phone:520-398-2333
Practice Address - Fax:520-398-9524
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOULISTIC MEDICAL INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-15
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031577Medicare Oscar/Certification
AZZ109948Medicare PIN