Provider Demographics
NPI:1548210461
Name:UNITED COMMUNITY HEALTH CENTER MARIA AUXILIADORA, INC.
Entity Type:Organization
Organization Name:UNITED COMMUNITY HEALTH CENTER MARIA AUXILIADORA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-407-5600
Mailing Address - Street 1:81 W ESPERANZA BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2667
Mailing Address - Country:US
Mailing Address - Phone:520-625-4401
Mailing Address - Fax:520-625-8504
Practice Address - Street 1:275 W CONTINENTAL RD
Practice Address - Street 2:STE 141
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-2024
Practice Address - Country:US
Practice Address - Phone:520-625-3691
Practice Address - Fax:520-547-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC-3915261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ84080Medicare ID - Type UnspecifiedGROUP MEDICARE #