Provider Demographics
NPI:1588834998
Name:TON SAN SIMON HEALTH CENTER
Entity Type:Organization
Organization Name:TON SAN SIMON HEALTH CENTER
Other - Org Name:SAN SIMON HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:520-383-7285
Mailing Address - Street 1:7900 S J STOCK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-7012
Mailing Address - Country:US
Mailing Address - Phone:520-295-2546
Mailing Address - Fax:520-295-2676
Practice Address - Street 1:WEST HIGHWAY 86, MILE MARKER 74
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-383-7251
Practice Address - Fax:520-383-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X
AZ261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZFACILITY NPIOther1588834998
AZ03D09569818OtherCLIA
AZ358933Medicaid
AZ03D09569818OtherCLIA
030074Medicare Oscar/Certification