Provider Demographics
NPI:1629840137
Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Other - Org Name:VALLEYWISE MOBILE HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:602-344-2830
Mailing Address - Street 1:PO BOX 29670
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9670
Mailing Address - Country:US
Mailing Address - Phone:602-344-8100
Mailing Address - Fax:
Practice Address - Street 1:2601 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4973
Practice Address - Country:US
Practice Address - Phone:602-344-5011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No282N00000XHospitalsGeneral Acute Care Hospital