Provider Demographics
NPI:1982917175
Name:MARANA HEALTH CENTER INC
Entity Type:Organization
Organization Name:MARANA HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-682-4560
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4560
Mailing Address - Fax:520-682-4570
Practice Address - Street 1:1346 N STONE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7338
Practice Address - Country:US
Practice Address - Phone:520-616-4944
Practice Address - Fax:520-616-4943
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARANA HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-16
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4723261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)