Provider Demographics
NPI:1508207960
Name:ARIZONA CITY HEALTH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ARIZONA CITY HEALTH ASSOCIATES, INC.
Other - Org Name:ELOY CITY HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:EFRAINS
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-466-5774
Mailing Address - Street 1:PO BOX 1775
Mailing Address - Street 2:
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85123-1290
Mailing Address - Country:US
Mailing Address - Phone:520-466-5774
Mailing Address - Fax:520-350-7859
Practice Address - Street 1:103 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85131-2055
Practice Address - Country:US
Practice Address - Phone:520-466-5774
Practice Address - Fax:520-350-7859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA CITY HEALTH ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ813868Medicaid