Provider Demographics
NPI:1407109093
Name:PADRE PIO CLINIC INC.
Entity Type:Organization
Organization Name:PADRE PIO CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:414-520-3896
Mailing Address - Street 1:3700 E WILLIAMS FIELD RD APT 2040
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7000
Mailing Address - Country:US
Mailing Address - Phone:414-520-3896
Mailing Address - Fax:
Practice Address - Street 1:3700 E WILLIAMS FIELD RD APT 2040
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7000
Practice Address - Country:US
Practice Address - Phone:414-520-3896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43966-020261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34152600Medicaid
WI34152600Medicaid