Provider Demographics
NPI:1922050319
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 1:1260 S CAMPBELL AVE
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-0503
Mailing Address - Country:US
Mailing Address - Phone:520-407-5606
Mailing Address - Fax:520-625-8504
Practice Address - Street 1:17388 W 3RD STREET
Practice Address - Street 2:
Practice Address - City:ARIVACA
Practice Address - State:AZ
Practice Address - Zip Code:85601
Practice Address - Country:US
Practice Address - Phone:520-407-5500
Practice Address - Fax:520-407-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-01-29
Deactivation Date:2007-01-04
Deactivation Code:
Reactivation Date:2008-06-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ84080Medicare PIN
AZ031804Medicare Oscar/Certification
AZZ84080Medicare PIN