Provider Demographics
NPI:1477612786
Name:MARANA HEALTH CENTER, INC
Entity Type:Organization
Organization Name:MARANA HEALTH CENTER, INC
Other - Org Name:CATALINA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:VATNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-682-4560
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4560
Mailing Address - Fax:520-682-3299
Practice Address - Street 1:3645 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3320
Practice Address - Country:US
Practice Address - Phone:520-862-4560
Practice Address - Fax:520-682-3299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARANA HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ060153Medicaid
AZ329592OtherAHCCCS GROUP
AZWMBRVMedicare PIN
AZ329592OtherAHCCCS GROUP