Provider Demographics
NPI:1417121765
Name:IMOGENE A BELL, INC.
Entity Type:Organization
Organization Name:IMOGENE A BELL, INC.
Other - Org Name:NOGALES CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMOGENE
Authorized Official - Middle Name:ADAIR
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-287-2726
Mailing Address - Street 1:480 N MORLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2930
Mailing Address - Country:US
Mailing Address - Phone:520-287-2726
Mailing Address - Fax:520-287-6159
Practice Address - Street 1:480 N MORLEY AVE
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2930
Practice Address - Country:US
Practice Address - Phone:520-287-2726
Practice Address - Fax:520-287-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN015488364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ190489Medicaid